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Sexual Truths All Should Know 

GIRL, WIFE 
MOTHER 

A guide for every girl and woman 
in all important periods of life, 
beginning with the transition 
from girlhood to womanhood. 
Written in plain and simple 
language, it contains 

Knowledge every young girl should have 
Knowledge every woman should have 
Knowledge every young wife should have 
Knowledge every mother should have, and 
should impart to her daughter 



MYER SOLIS-COHEN, A.B., M.D. 



E HOUSE 



■f 
in 



r xV X v 



Y 



K 



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Copyright, 1912, by 
THE INTERNATIONAL BIBLE HOUSE 



Copyright, 1911, by 
The John C. Winston Co. 






INTRODUCTION 

BY THE 

PUBLISHERS 



This book is primarily for the education of 
young girls, wives and mothers in Sexual Knowl- 
edge. The author says in the preface, "Few 
mothers have sufficient knowledge to instruct 
cheir daughters properly . ' ' Furthermore , every 
mother feels a certain reticence in talking to 
her daughter on this subject, and yet she feels 
that it is a part of her duty as mother to convey 
: %h knowledge to her daughter. Every mother, 
before, it is safe to say, has often wished for 
\ook she could give her daughter, containing 
Knowledge every young girl should have; 
Knowledge every woman should have; 
Knowledge every young wife should have ; 
Knowledge every mother should have, and 
should impart to her daughter. 
The spirit of the times is to educate along all 
lines that lead young and old to a better under- 
standing of the proper uses of all things. The 



INTRODUCTION BY THE PUBLISHERS 

day is past for the old idea that "where ignor- 
ance is bliss, 'tis folly to be wise." It is truer 
to-day than ever before that "knowledge is 
power.' ' Life is too short, and the value of one 
human life is too great, and the power of woman- 
hood is too essential to the highest civilization to 
leave our young girls in ignorance of the knowl- 
edge contained in this book, when the lack of 
such knowledge may wreck their lives, or may 
so misdirect their thoughts or acts that they 
will come far short of attaining to that physical 
and moral and religious development necessary 
to a life of health and happiness and beauty 
of character. 

Sexual Education is one of the most impor- 
tant subjects in the public mind of to-day, and 
many advocate that it should be a part of our 
system of public schools. Quoting from Chap- 
ter V, on "Sexual Education/ ' the writer says: 
"Why may we not have the teaching in the 
public schools embody this matter, with women 
physicians for girls and men physicians for boys, 
teaching them concerning these things which must 
be known if we are going to save the future <>ener- 



INTRODUCTION BY THE PUBLISHERS 

ationV This touches on the subject we now 
hear so much about, "Save Our Girls.' ' It is 
believed by the best people everywhere that 
the surest way of protecting the innocent is to 
educate them, so it follows that no education is 
more important than that of our young girls in 
all important periods of life, beginning when 
they are young and in greatest need of proper 
knowledge to guide them safely and wisely all 
along the pathway of life. It does not protect 
from danger to be kept in ignorance of the pit- 
falls into which so many have fallen. Danger 
signals and safeguards are needed, but the only 
safe and reliable guide is enlightenment, and it is 
to provide proper Sexual Knowledge for young 
girls, wives and mothers, that this book is 

Published and Sold Direct to Purchasers 
Exclusively by 

THE INTERNATIONAL BIBLE HOUSE 

Book and Bible Publishers 
Philadelphia, Pa. U. S. A. 

Notice. — This book is not sold through agents nor in 
book stores, so can be obtained only by sending direct to 
the Publishers. 



PREFACE 

F N this book the author has endeavored to 
present information that every woman 
should possess in order to preserve her health and 
vigor and that of her children. Few mothers 
have sufficient knowledge to instruct their daugh- 
ters properly. The physician seldom is given the 
opportunity or takes the time to teach well people 
how to live. For her guidance, therefore, a 
woman must depend upon reliable articles and 
books written especially for her. 

This book does not attempt to teach treatment 
of disease; its object is to tell girl, wife and 
mother what to do and what to avoid doing in 
order that she may lead a healthy life. It is 
written in plain and simple language, with an 
avoidance of medical terms, so as to be easily 
understood. All directions are specific and definite 
that they may be readily followed. 

MYER SOLIS-COHEN. 
November I, 191 1. 



CONTENTS 



Chapteb Pagk 
I. Knowledge the Greatest Factor in Pre- 
serving Health. 
Popular Instruction. Prevalence of Errone- 
ous Notions. Learning the Truth. Edu- 
cation for Motherhood 1 1 

II. The Generative Organs. 

Sex Throughout Nature. Female Sexual 
Organs in Plants and the Lower Animals. 
The Uterus or Womb. The Vagina. The 
Appendages 18 

III. Adolescence. 

The Changes that Occur at Adolescence. The 
Influence of Climate and Race. Mode of 
Life and Heredity. Delay in the Appear- 
ance of Menstruation. Mental and Spir- 
itual Changes at Puberty. Periods of 
Storm and Stress and of Doubt. Aliena- 
tion and Reconstruction. Growth With- 
out Definite Transitions 23 

IV. The Hygiene of Puberty. 

Air, Food, Bathing, Sleep. Avoidance of 
Overwork and Excitement. Preparing the 
Girl for Puberty. A Mother's Confidence. 30 

(v) 



vi CONTENTS 



Chapter Page 

V. Sexual Education. 

An Educational Question. Instilling the 
Truth into the Girl's Mind. A Woman's 
Right to the Facts. A Mother's Respon- 
sibility. Teaching the Young. Solitary- 
Vice 35 

VI. The Monthly Phenomena. 

Ovulation. The Physiology of Menstrua- 
tion. The Menstrual Flow. Other Men- 
strual Symptoms. The Hygiene of Men- 
struation 42 

VII. The Disorders of Menstruation. 

Causes, Symptoms and Treatment of Absent 
Menstruation. Sudden Checking of the 
Menstrual Flow. Scanty Menstrual Flow. 
Profuse Menstrual Discharge or Flooding. 
Two Alternatives. Vicarious Menstrua- 
tion. Dysmenorrhea or Painful Menstrua- 
tion: Causes; Treatment. Management 
During the Period 49 

VIII. The Menopause. 

The Age at Which the Menopause Occurs. 
Physiology of the Climacteric. Symptoms 
of the Menopause. Danger Signals. Hy- 
giene of the Menopause 62 

IX. The Crusade Against Cancer. 

How Cancer Grows. The Danger of Delay. 
The Parts Usually Attacked. Warning 
Symptoms. Proper and Improper Treat- 
ment. A Yearly Examination 69 



CONTENTS vii 






Chapter Page 

X. The Guarantee of Safety in the Marriage 
Contract. 

Preventing the Marriage of the Unfit. In- 
fection Through Marriage. The Distribu- 
tion of Literature. Presenting the Facts. . 79 

XL Providing for the Health of the Unborn. 

Protecting the Children. Frankness Con- 
cerning Hereditary Disease. The Day of 
Reckoning. Where the Hereditary Taint 
is Slight. Drunkenness an Obstacle to 
Marriage. Insanity and Epilepsy a Bar to 
Marriage. Deaf -mutism in its Relation 
to Marriage. Instinctive Criminality a 
Form of Degeneracy. Heredity Sometimes 
a Factor in Consumption. The Marriage 
of Syphilitics. Consanguineous Marriages . 85 

XII. Reproduction Throughout Nature. 

An Explanation of Nature's Mysteries. Re- 
production: in Plants, in the Lower Ani- 
mals, in Man. Conception. The Devel- 
opment and Nourishment of the Embryo 
or Unborn Child. The Placenta and Um- 
bilical Cord. Changes in the Mother Dur- 
ing Pregnancy 94 

XIII. The Signs of Pregnancy. 

Determination of the Existence of Pregnancy. 
The Commonest Symptoms of Pregnancy: 
The Cessation of Menstruation; Morning 
Sickness; Appearance of the Face; Changes 
in the Breasts; Changes in the Size, Shape, 
and Appearance of the Abdomen. Quick- 



CONTENTS 



Chapter Page 

ening. Alterations, in the Nervous Sys- 
tem. Change in Color of the Mucous 
Membrane. Hearing the Fetal Heart 
Sounds. The Physician's Examination. . . 99 

XIV. The Hygiene of Pregnancy. 

Diet. Dress. Bathing. Work, Exercise 
and Rest. Maternal Impressions. Care 
of the Breasts. Marital Relations During 
Pregnancy. Attention to Teeth. Avoid- 
ance of Constipation. Medical Super- 
vision During Pregnancy 106 

XV. Sterility. 

Causes of Sterility in Women. Prevention. 
Cure. Race Suicide 1 15 

XVI. Miscarriage and Its Prevention. 

Causes. The Signs of a Miscarriage. The 
Danger of an Abortion or Miscarriage. 
Prevention. To Avert a Threatened 
Miscarriage. Treatment of an Inevitable 
Miscarriage. The After Treatment of a 
Miscarriage 122 

XVII. Preparations for the Confinement. 

The Lying-in Room. Arrangement of the 
Bed. Things Needed for the Confinement. 
The Baby's Basket. The Baby's Clothes. 
Preparation of the Patient. Engaging the 
Accoucheur. Physician vs. Midwife. The 
Selection of a Nurse. The Nurse's Duties. 130 



CONTENTS ix 



Chapter Page 

XVIII. Childbirth. 

Causes of Labor. How to Calculate the Day 
of Confinement. The Duration of Preg- 
nancy. Methods of Calculation. Im- 
portance of Knowing the Date of the Last 
Menstruation. Childbirth or Labor. The 
First Stage of Labor; the Second Stage; 
the Third Stage. The Puerperium. After- 
pains. Difficulty of Urination. Changes 
in the Breasts 143 

XIX. Management of Labor. 

The Diagnosis of Labor. Duration of Labor. 
A Talk on Germs. Infection of the Birth 
Canal. Prevention of Puerperal Infection. 
Surgical Cleanliness Throughout Labor. 
The Management of the First Stage of 
Labor. Management of the Second Stage. 
Care of the New-born Infant. Treatment 
of an Asphyxiated Baby. Care of the 
Mother During the Third Stage of Labor. . 156 

XX. The Care of the Mother After Labor. 

Rest and Quiet. Hygienic Regime. Rules 
Concerning Urination. Attention to the 
Bladder and Bowels. Care of the Breasts. 
Congested and Distended Breasts 174 

XXI. The Care of the Baby. 

The High Mortality of Infants. The New- 
Born Baby. The Baby's Weight. Regu- 
lation of the Bowels. The Baby's Food. 
Breast Feeding. - Modifying the Breast 
Milk. Bottle Feeding. Bottle and Nipple. 
When the Bottle Disagrees. The Feeding 
of Older Children. Water. The Baby's 



CONTENTS 



Chapter Page 

Clothing. Bathing the Baby. Sleep and 
Rest. Exercise and Fresh Air. Digestive 
Disorders of Infancy. Colic. Contagious 
Diseases 184 

XXII. The Causes of Woman's Diseases and Their 
Removal. 

Mismanagement During Childbirth. Impru- 
dence After Labor. Artificial Termination 
of Pregnancy. Unhygienic Marital Rela- 
tions. Personal Purity a Factor. Chronic 
Constipation. The Majority of Women's 
Diseases Preventable 209 

XXIII. Clothing and Posture in Relation to Dis- 

ease. 

Underwear. Shoes. Harmfulness of the 
Ordinary Corset. The Proper Shape for 
a Corset. Supporting the Skirts. Incor- 
rect Posture. How to Maintain a Proper 
Position. To Sit and Walk Properly 217 

XXIV. The Role of Air, Food, Bathing, Exercise, 

Rest and Recreation in Maintaining 
One's Health. 
Fresh Air. Food. The Cleansing Bath. 
The Cold, Hygienic, or Hardening Bath. 
Exercise. The Necessity for Rest and 
Recreation 227 

XXV. The Temporary Relief of Symptoms. 

Emergencies. Temporary Treatment of Pain. 
Headache. Backache. Abdominal Pain. 
A White Vaginal Discharge. A Yellow 
Discharge. A Bloody Discharge. Dan- 
ger in Patent Medicines 239 



CHAPTER I. 



KNOWLEDGE THE GREATEST FACTOR IN 
PRESERVING HEALTH, 

Popular Instruction. Prevalence of Erroneous Notions. 
Learning the Truth. Education for Motherhood. 

The medical world is beginning to realize that 
the aid of the people themselves is required to 
prevent disease. The physician is called in only 
after a person has fallen ill. Then it is too late 
for prevention. Seldom, indeed, do persons in 
health come to a physician for advice. There is 
need, therefore, of other means of imparting 
information, such as books, articles in newspapers 
and magazines, lectures, pamphlets, exhibitions 
and societies formed for the purpose of combat- 
ing disease. 

Little headway against tuberculosis was made 
until the people were taught its nature, preven- 
tion and cure, and joined associations for stamp- 
ing it out. Questions concerning the milk supply, 
the care of infants and school children, the pre- 
vention of social diseases, and other matters, are 

(ID 



12 KNOWLEDGE THE GREAT FACTOR 

being solved similarly. In many cities, for in- 
stance, public lectures on the care of the baby are 
given to mothers, being sometimes supplemented 
by personal instruction in the homes. 

The Prevalence of Erroneous Notions. 

The amount of ignorance that exists to-day 
despite all these measures for public enlighten- 
ment is really surprising. One would scarcely 
believe how many false ideas are prevalent as to 
the nature, abnormalities and hygiene of the dif- 
ferent epochs of a woman's life. Even more 
incredible is the number of seemingly intelligent 
women who believe and repeat as facts the impos- 
sible nonsense they hear. The light of civilization 
that dispelled most of the superstitions of the dark 
ages seems never to have reached the old wives' 
tales. In regard to much that concerns herself 
and her children, the average woman is woefully 
ignorant, not because she does not desire knowl- 
edge, but because her usual sources of information 
are other women as ignorant as she. 

Pitiful indeed is the position of the young wife. 
She soon finds herself surrounded by acquaint- 
ances and friends, all eager, under the guise of 
giving sound advice, to pass on to her the tradi- 
tions of their sex. With what self-satisfaction 



KNOWLEDGE THE GREAT FACTOR 13 

does each grasp the opportunity to pose as an 
oracle! But, bad as they are, the foolish fables 
are not the worst things that women whisper. 
Before many months the bride learns, often for 
the first time, the baseness of many of her married 
friends, who in confidential chats sully her mind 
with degrading suggestions. Especially on be- 
coming pregnant is she forced to realize their 
hardness, their hollowness and their heartlessness. 
She is made acquainted with a new philosophy of 
life, based on selfishness, which ignores the pri- 
mary object of marriage. 

The strong, womanly woman, who remains 
true to herself and to her sex, withstanding the 
assaults of the vicious, must still run the gauntlet 
of the ignorant. Her so-called friends will repeat 
to her all the tales they have heard concerning 
her condition, never neglecting to include and 
emphasize all its complications. They portray 
pregnancy as a state of abject misery, beset on 
every hand with the gravest risks. Folk-lore, 
handed down from time immemorial and abso- 
lutely wanting in fact, is recited with a positive- 
ness that would be ludicrous were it not pathetic. 

The crowning horror they herald is the 
approaching confinement. Exaggerating every 
phase, making the pain and the danger many 



14 KNOWLEDGE THE GREAT FACTOR 

times the reality, they take delight in dwelling on 
the accidents and abnormalities, no matter how- 
rare, and in describing with all their gruesome 
details the fatal cases they have known. Not 
infrequently they even profess to detect in the 
poor woman they address symptoms similar to 
those shown by the patients that died. 

Learning the Truth. 

The young wife, who at such a time is in need 
of encouragement, sympathy and support, is thus 
cruelly frightened by the falsehoods uttered by 
her friends, who no doubt are more often thought- 
less and ignorant than cruel and deliberately 
deceiving. 

Strange as it may seem, a woman seldom 
appeals to her physician or discusses with him the 
things she hears, although she could thus readily 
learn the truth. The reader is strongly urged to 
consult her physician whenever in doubt. She 
will always find him willing and glad to instruct 
her. 

As an additional source of information this 
little volume has been written, so that any woman 
can always readily obtain the facts and not be at 
the mercy of her ignorant friends. In it the 
various periods of a woman's life are explained, 



KNOWLEDGE THE GREAT FACTOR 15 

beginning with the transition from childhood to 
womanhood and continuing through pregnancy 
and childbirth to change of life. The hygiene 
and the physiology of each period are both given, 
so that a woman will not only know how to live, 
but will understand the reason for everything she 
does. While teaching chiefly how to keep well 
and avoid sickness, the book also tells how to 
recognize dangerous symptoms and what to do in 
emergencies before the doctor comes. 

Throughout the whole of life, knowledge is 
one's greatest safeguard against disease. Much 
avoidable injury is done by the ignorant woman 
who frequently imagines that suffering is her 
natural lot, and often views with complacency 
symptoms of the gravest import. How many 
deaths from cancer could have been prevented 
had the patient recognized as important the first 
signs of her trouble and not put off mentioning 
them until all chance for cure had passed ! 

Education for Motherhood. 

It is not always for her own health alone that 
a woman must care. Often in her hands is the 
regulation of other lives. On the inexperienced 
mother, therefore, a great responsibility rests. 
As an eminent gynecologist has remarked: 



16 KNOWLEDGE THE GREAT FACTOR 

"The most important factor in the development 
of a healthy girl baby into a healthy young 
woman is an intelligent mother, and no more 
urgent problem calls for solution to-day than that 
of securing adequate training for the duties of 
maternity. Maternal instinct and maternal love 
plus family traditions are not sufficient equip- 
ments for rearing a healthy family. They must be 
guided by maternal intelligence. . . The health 
of the growing girl begins with the education of 
her mother/' 

Education for motherhood occupies a promi- 
nent place in this book. Instruction is given in 
the care of the baby, including its food, clothing, 
bathing, sleep, rest and exercise. Of equal im- 
portance to the wife and the mother is an allied 
subject that in the past has received too little 
attention — the protection of girls and women by 
their enlightenment on sexual matters. No longer 
are ignorance and innocence regarded as syn- 
onymous. The former, in fact, is now believed 
even to endanger the latter. Many mothers, how- 
ever, who recognize the need of instructing their 
children in regard to sex and reproduction, are 
at a loss to know how to approach the subject. 
They feel almost helpless when they consider their 
own insufficient knowledge. What a girl has a 



KNOWLEDGE THE GREAT FACTOR 17 

right to know forms the basis of several chapters, 
easily told in the simple manner that a mother 
might well adopt herself in presenting the matter 
to her children. Under the headings "The Guar- 
antee of Safety in the Marriage Contract" and 
"Providing for the Health of the Unborn" is 
plainly stated w T hat a woman has a right to 
demand before entering marriage, in order that 
she herself may remain imdefiled and her children 
be brought into the world sound in mind and in 
body. 

The reader must not imagine herself compe- 
tent to detect or treat disease, whether occurring 
in herself or in her children. She should be care- 
ful always to consult her physician at the first 
signs of illness and to follow strictly his advice. 
The book, however, acquaints her with the infor- 
mation that every woman should possess in order 
to keep well and strong and rear a healthy and 
happy family. 



CHAPTER II. 



THE GENERATIVE ORGANS. 

Sex Throughout Nature. Female Sexual Organs in Plants 
and the Lower Animals. The Uterus or Womb. The 
Vagina. The Appendages. 

Sex Throughout Nature. 

All living matter possesses the power of repro- 
duction. This is one of the characteristics that 
distinguish it from non-living matter. In the 
higher forms of life, both animal and vegetable, 
a speeral portion of each organism is set apart for 
this distinct purpose. The elements necessary to 
the formation of a new plant or animal are as a 
rule not all found in one individual, but are di- 
vided between two, which are known respectively 
as the male and the female. A union of these two 
elements is usually required to form the new 
organism. The offspring develops from one ele- 
ment, the female, as soon as the male element is 
added to it. This distinction of sex occurs in 
flowers, the stamens representing the male, the 
(18) 



THE GENERATIVE ORGANS 19 

pistil the female. Willow trees show still further 
sexual differentiation, some producing only those 
catkins, or pussy-willows, which consist entirely 
of pistils, and others blossoming only into stamen- 
bearing catkins. In the familiar corn or maize 
the "tassel" is the male flower, the "silk" the 
female. 

Female Organs in Plants and the Lower Animals. 

In the center of every flower stands the pistil, 
the upper portion forming the style and the 
stigma, the deep-seated portion being the ovary, 
which contains the ovule. When the flower is 
fertilized by the male element — the pollen — the 
ovary begins to develop and to form seeds, which, 
when planted, put forth leaves and stalks and 
finally bear flowers, just as did their parents. 
The pod with its peas or beans, and the apple 
or pear with its seeds, represent the ovary of the 
plant. 

In the animal kingdom sexual organs are pos- 
sessed by even the lowest members. The ovary 
of the fish, for instance, is familiar as the roe. 
It contains countless ova which, when deposited, 
are known as spawn. These ova, upon being fer- 
tilized, become the eggs, from which later the 
baby fish are hatched. 



20 THE GENERATIVE ORGANS 

In birds the ovum is fertilized while in the 
ovary, then being laid in the form of an egg, 
to be hatched outside the mother's body. Every 
woman who has dressed a hen has seen the ovary 
with the unfertilized ova and the fertilized eggs. 

In all the lower animals the embryo, as the 
unborn offspring is called, develops and obtains 
its food outside the parent's body. The chick, 
for example, lies within an egg, nourished by the 
white and the yolk, and protected by the shell. 

In the higher animals the offspring must ob- 
tain its nourishment from its mother while it is 
developing as well as after it is born. It must 
also be protected by her body. The organ in 
which the embryo lies, while being formed into a 
living animal, is called the uterus or womb. 

The Uterus or Womb. 

In woman the uterus, or womb, is a hollow 
organ, shaped like an inverted pear, about two 
inches and a half long, one inch and a quarter 
wide, and three-quarters of an inch thick. The 
walls are composed of thick muscles enclosing a 
triangular cavity just big enough to hold the 
contents of about half a teaspoonful. The uterus 
ends below in a neck, called the cervix, traversed 
by a narrow canal, called the cervical canal, an 



THE GENERATIVE ORGANS 21 

inch and a half long. The upper end of this 
canal, where it opens into the cavity of the 
uterus, is called the internal os or mouth; the 
lower opening into the vagina is known as the 
external os or mouth. The body and the neck 
of the womb are both lined with a membrane con- 
taining glands, which secrete mucus. 

The Vagina, 

The neck of the womb projects into a tube, 
called the vagina, about four inches long. The 
walls of this tube lie normally in contact, but are 
capable of being stretched to a considerable ex- 
tent. The vagina is also lined with a mucous 
membrane containing glands that secrete mucus, 
which acts as a lubricant. It opens externally, 
but in a maiden is partially covered by a thin 
membrane called the hymen. 

The Appendages. 

The uterus is supported by means of ligaments 
fastened to each side and attached to the bones. 
It is slung between the two ligaments just as a 
person is supported in a hammock. 

Along the upper border of the ligaments lie 
the oviducts or Fallopian tubes, which open into 
the womb at the top on each side. They are 



22 THE GENERATIVE ORGANS 

narrow tubes, about four inches long, running 
outward from the corners of the womb and open- 
ing like funnels at their other extremities, where 
they are in contact with the ovaries, connecting 
them with the womb. They also are lined with 
mucous membrane. 

The ovary is like an almond in shape and size, 
and hangs in the fold of the ligament just below 
the Fallopian tube, at its distal end. It is a gland 
secreting ova, or eggs. It probably also secretes 
a substance necessary to woman's health, about 
which not much is known. 

The uterus and its appendages, as the tubes 
and ovaries are called, lie in a bony basin, called 
the pelvis. 



CHAPTER III. 



ADOLESCENCE. 

The Changes that Occur at Adolescence. The Influence of 
Climate and Race. Mode of Life and Heredity. Delay 
in the Appearance of Menstruation. Mental and 
Spiritual Changes at Puberty. Periods of Storm and 
Stress and of Doubt. Alienation and Reconstruction. 
Growth Without Definite Transitions. 

In the child the sexual organs are but partially 
developed and remain inactive. At about the 
end of the fourteenth year, however, they begin 
to functionate, and the girl becomes capable of 
reproduction. The period at which this occurs is 
called puberty or adolescence. 

In addition to the changes in the generative 
organs, other alterations take place in girls at 
this period. The figure begins to assume the 
aspect of womanhood, the breasts become devel- 
oped, the pelvis and abdomen enlarge, the voice 
undergoes a change, hair appears in the arm- 
pits and about the pubic region, and the men- 
strual flow, or monthly sickness, is established. 
(23) 



24 ADOLESCENCE 



The Influence of Climate and Race. 

Although puberty usually occurs about the 
thirteenth or fourteenth year, it may appear 
earlier or later, its onset being influenced by 
climate, race, modes of life, and heredity. In 
tropical climates it may occur at nine or ten years 
of age ; in Egypt and Sierra Leone it occurs nor- 
mally at ten years. In these climates it is said 
not to be an uncommon thing for a girl to be a 
mother at twelve. 

Puberty occurs late in the cooler climates, and 
among the peoples normally inhabiting them. In 
Lapland, for instance, menstruation does not ap- 
pear until the eighteenth year. The Teutonic 
and Anglo-Saxon races while in their European 
homes arrive at adolescence oftenest when fifteen 
years of age. In the United States and Canada 
puberty usually occurs about the fourteenth or 
fifteenth year. 

In Hungary the three races, Slavonic, Magyar 
and Jewish, living side by side in the same cli- 
mate, reach adolescence when sixteen, fifteen and 
thirteen years of age, respectively. Hindu girls 
of Calcutta and negresses of Jamaica, also living 
in the same climate, begin menstruating at the 
eleventh and fifteenth year, respectively. Some 
writers state that blondes mature earlier than 



ADOLESCENCE 25 



brunettes. Menstruation among Jewesses begins 
a year or two in advance of other races in this 
country. In negroes and Creoles the monthly 
sickness appears earlier than in white people. 

Mode of Life and Heredity. 

The influence of city life, with its excitement 
of parties, theatres, association with the other 
sex, and sexual temptations, tends to hasten the 
oncoming of puberty. 

It is said that diet has an influence, that stimu- 
lating foods, such as pepper, vinegar, mustard, 
spices and condiments generally, tea and coffee, 
and an excess of animal food, have a clearly 
appreciable influence in prematurely bringing 
about this condition. 

Heredity may affect the time of puberty, it 
being a matter of common observation that in 
some families menstruation may begin early 
through several generations. 

Delay in the Appearance of Menstruation. 

Although other signs of puberty may occur at 
the usual time, the menstrual flow is sometimes 
late in making its appearance. This is usually 
due to a condition of anemia or impoverished 
blood, caused by want of sufficient sunlight, fresh 



26 ADOLESCENCE 



air, exercise, good food and sleep, and by a too 
close application to study. 

In the opinion of Professor Kelly, of Johns 
Hopkins University, it is unreasonable to antici- 
pate normal puberty in the weak, poorly 
nourished, and imperfectly developed girl who 
has been permitted to violate the laws of health 
throughout childhood. He regards it useless to 
concentrate attention upon one period of a girl's 
life and to attempt by over solicitude at this time 
to remedy the effects of early mistakes in 
hygienic living and hereditary tendencies. 

Mental and Spiritual Changes. 

As womanhood unfolds, other changes occur 
besides those of the body. The girl is in a state 
of restlessness and of nerve irritability ; her mind 
is confused with feelings of undefined longings 
and desires, and of vague dissatisfaction with all 
about her. She often tends to become morbid, 
fanciful, self-conscious and supersensitive, and 
her feelings are easily hurt. 

During adolescence a marked event in the spir- 
itual life frequently occurs, which is usually asso- 
ciated with apparently sudden changes of char- 
acter. This phenomenon, known as conversion, 
is confined almost wholly to the years between 



ADOLESCENCE 27 



nine, or ten, and twenty, between the innocence 
of childhood and the fixed habits of maturity, 
while the girl is yet impressionable and has 
already capacity for spiritual insight. 

Sometimes the attainment of spiritual life is 
simply a process of even and continuous develop- 
ment. According to Dr. Starbuck, late in child- 
hood, at the beginning of adolescence, there is a 
more or less definite clearing of the religious 
atmosphere. The ideas of God and duty and 
religious observance, which have been external 
to the child during the earlier years, now take 
root in her life and have a vital significance. 
Heretofore they have been embodied in precept 
or custom, or in her own playful imagination. 
Now they have begun to be her own. 

Periods of Storm and Stress, and of Doubt. 

Nearly three-fourths of all girls at this time 
go through a period of storm and stress, which 
manifests itself in a number of ways. There may 
be present a sense of incompleteness and imper- 
fection; brooding, depression, and morbid in- 
trospection ; distress over doubts ; friction against 
surroundings ; effort to control passion. The help- 
lessness that comes with storm and stress is often 
cured by inducing wholesome activity. 



28 ADOLESCENCE 



About half the girls also go through a period 
of doubt. If parents and Sunday-school teachers 
would realize this mental attitude, and meet it 
with tact and wisdom, they could often guide the 
girl safely through this difficult epoch in her 
spiritual life. 

Alienation and Reconstruction. 

As it is, about a third of all women pass finally 
through a period of alienation, due, according to 
Starbuck, to doubt, storm and stress, ill health, 
environmental conditions, necessity of gaining re- 
laxation, the necessity to preserve in one way or 
another the wholeness of the individual life, and 
the pleasure that comes from the sense of 
freedom. 

The close of adolescence is marked by the 
period of reconstruction. This reconstruction, 
Starbuck says, consists either in working out 
one's belief and faith independently of that of 
other people, accepting one's own point of view 
and beginning to live it and be happy in it, or 
in coming back to the old forms and dogmas 
of childhood and putting new life into them. 

Growth Without Definite Transitions. 
Sometimes instead of sudden conversion, a 
growth without definite transitions occurs. This 



ADOLESCENCE 29 

is favored by religious surroundings in child- 
hood; by keeping children reasonably free from 
dogma which they are incapable of assimilating; 
and by carefully meeting the needs of the child 
at every point in its development. It is more 
likely to occur when there is a certain mixture 
of faith and doubt continually and a sufficient 
degree of freedom to question all things to insure 
a clear horizon, and enough trust and insight and 
poise of spirit to remain firmly rooted in the 
heart of religion, 



CHAPTER IV. 



THE HYGIENE OF PUBERTY. 

Air, Food, Bathing, Sleep. Avoidance of Overwork and 
Excitement. Preparing the Girl for Puberty. A 
Mother's Confidence. 

The hygiene of puberty should properly be a 
continuation of the hygiene of childhood. 
Adolescence produces the least trouble when the 
girl has observed the laws of health from infancy. 
It is between the ages of twelve years and a half 
and fourteen and a half, however, that the great- 
est growth occurs. Unfortunately, as a rule, the 
strength does not increase proportionately. Dur- 
ing this period, therefore, a girl frequently neg- 
lects to hold herself erect, and experiences 
difficulty in concentrating her attention. 

Air, Food, Bathing, Sleep. 

Fresh air is essential during these years. Much 
time should be spent out of doors, in walking 
and playing games that do not fatigue or excite. 
Contests, however, are to be avoided. 
(30) 



THE HYGIENE OF PUBERTY 31 

Proper food in sufficient quantity is necessary 
to provide material for the rapid growth. 

A cold hygienic, stimulating, or hardening, 
bath should always form part of the morning's 
toilet, especially at this period. It may be taken 
as a cold rub or sponge, a shower, or a plunge. 
It is of very brief duration — a few seconds 
merely, and is followed immediately by a brisk 
rub with a dry, rough towel until the skin is in a 
pink glow. Twice a week a warm cleansing bath 
with soap should be taken, best immediately be- 
fore retiring, and always followed by a quick rub 
with cold water to prevent taking cold. 

No less than nine hours of sleep are required. 
The bedroom windows should be opened widely 
both in summer and in winter. If a girl goes to 
bed wholesomely tired she is likely to fall 
promptly into a sound sleep undisturbed by 
dreams. She must not be permitted to lie abed 
after waking in the morning. 

Avoidance of Overwork and Excitement. 

Overwork in school, especially in an ill venti- 
lated, unhygienic building, is to be avoided. 
Naturally, some of the hours out of school must 
be devoted to study ; but if every other available 
minute is taken up with household duties and 



32 THE HYGIENE OF PUBERTY 

practicing music, no time is left for exercise in 
the open air. The mental and physical strain of 
several consecutive hours at the piano is dis- 
tinctly harmful. Long periods of sewing on the 
machine are also considered objectionable. Light 
duties, however, give a girl something to occupy 
her mind and take her thoughts off herself. 

It is well to keep the girl free from excitement 
and especially from the strain and stress of emo- 
tional life. Her thoughts should be diverted 
from sexual matters, all associations and modes 
of life having such a tendency being discouraged. 
A wise supervision over books and companions 
is important. By encouraging outdoor life and 
interests, allowing healthful amusements and 
judicious exercise, both mind and body are pre- 
vented from running into morbid states. There 
will then be less tendency for the girl's thoughts 
to become centered upon herself and upon her 
sexual organs. The development of improper 
habits will also thereby be rendered less likely. 

The hygiene of the menstrual period itself is 
discussed in a succeeding chapter. 

Preparing the Girl for Puberty. 

The importance of a duty that many mothers 
shirk is thus presented by Dr. Jane Walker : 



THE HYGIENE OF PUBERTY 33 

"Mothers and guardians of girls should obtain 
their entire confidence with regard to their 
monthly functions ; it will save much misery both 
to body and mind. 

"Here let me say that it is the duty of a 
mother to be open with her girl in this connec- 
tion. When, from the changes that are occur- 
ring in the girl's body, her mother suspects that 
menstruation is about to take place, it is her duty 
to tell her what lies before her. What she will 
say will vary with the daughter's age, and also 
with the extent of the mother's own knowledge. 
If the latter has some acquaintance with phys- 
iology and natural science, she will be in a better 
position with regard to this question than one 
who has had no scientific teaching at all. Prob- 
ably the simplest plan is to draw the girl's atten- 
tion to the various signs of approaching woman- 
hood, and then to tell her that this is one of 
them. In whatever way the communication is 
made, it must not be omitted, for no one can 
realize the shock endured by a perfectly ignorant 
girl on experiencing her first monthly period. 
Many of the ills suffered in later life are traceable 
to neglect and ignorance at this time. Moreover, 
if the mother does not herself tell the girl, some- 
one else will probably do so, and the communica- 



34 THE HYGIENE OF PUBERTY 

tion may be made with coarseness, which will 
have an injurious effect on the girl's character. 
A mother should at this period of her life be a 
girl's best friend, with whom she feels there can 
be no reserve." 

A Mother's Confidence. 

Dr. Button emphasizes that, as the girl ap- 
proaches puberty and is instructed regarding 
what is about to occur, it must be impressed upon 
her that her mother and her physician are her 
confidential advisers, either of whom she can 
freely consult regarding any trouble with the 
menstrual function, without being considered at 
all immodest; that she may discuss the subject 
freely with her mother or physician for the pur- 
pose of information and advice, and maintain her 
dignity and modesty ; but that to discuss it lightly 
with companions, in jest, is improper, immodest 
and vulgar. 



CHAPTER V. 



SEXUAL EDUCATION. 

An Educational Question. Instilling the Truth into the 
Girl's Mind. A Woman's Right to the Facts. A 
Mother's Responsibility. Teaching the Young. Soli- 
tary Vice. 

Several years ago at their annual meeting the 
physicians of America held a symposium on the 
Duty of the Profession to Womankind. Among 
the topics discussed were "The Protection of the 
Innocent," and "The Guarantee of Safety in the 
Marriage Contract." 

An Educational Question. 

"The question of protecting the innocent," de- 
clared Dr. Howard, of Baltimore, "is neither 
medical nor legal in the strict meaning of those 
terms, but educational. There is only one remedy 
for all acts whose basal cause is ignorance, and 
that is education. In this matter the objects for 
attack are the mothers and teachers; the sub- 
jects for education are the young girls. . . . 
(35) 



36 SEXUAL EDUCATION 

'There are thousands of girls in the upper and 
middle classes who, while not innocent, are igno- 
rant of the primal laws of Nature. Many have 
tried to get the information their adolescent long- 
ings crave; many have striven to seek out the 
mystery after having been snubbed or denied by 
their own mothers. If the opportune moment 
arrives, and it generally does, the girl falls into 
the salacious seductiveness of some vicious 
minded woman, the seeds of false sexual educa- 
tion are sown, and their growth forever crowds 
out the tender tie between mother and daughter, 
and, as the mother dissembled, so will the 
daughter lie. 

[ Instilling the Truth Into the Girl's Mind. ^ 

"As I have suggested, the truth as we know it, 
should be instilled into the mind of every girl. I 
should commence when they are very young by 
teaching them the beautiful laws and arrange- 
ments of Nature in the reproduction of plants 
and flowers, emphasizing the sex differentiation. 
Gradually, as she mentally develops, she should 
be led along Nature's path up to the reproduc- 
tion of birds, then animals ; explaining their mat- 
ing habits and the reasons therefor. When 
Nature was giving the girl the first early signs 



SEXUAL EDUCATION 37 

of her own reproductive power she should have 
the whole truth plainly told her. Now the girl 
will see the beauty, the wonderful, the ethical 
side of a normal sexual feeling, and sensual sen- 
sation will be suppressed. She will seek for no 
mysteries to dream about, have no morbid 
curiosity to lead her to experiment, but be in the 
normal condition of a healthy woman who knows 
and will be master of natural passions until her 
time of mating comes. " 

Dr. Nelson, of Chicago, stated his belief that 
the majority of the girls who fall, do so because 
of want of instruction. He said that even phy- 
sicians fail to instruct their own children as they 
should before puberty; they have left it for the 
teacher, the Sunday-school teacher, the pastor, 
and these, in turn, have left it to someone else, 
and as a consequence the children get their educa- 
tion along this line on the street. Education in 
this subject, he said, must be commenced in the 
family; it is the parents' business to teach their 
children. 

A Woman's Right to the Facts. 

At an open meeting held in Philadelphia about 
a year ago the question was discussed : "Have 
Our Women and Girls a Right to the Facts Re- 



SEXUAL EDUCATION 



garding Social Disease? If so, How Shall They 
Best Obtain Them?" 

The president of a Boys' and Girls' Club said : 
"It appears to me that we are discussing the 
question upon the false supposition that women 
and girls are not at all conversant upon this sub- 
ject, and we ask whether we shall go to women 
w T ho are happy in their ignorance with the un- 
welcome information in our possession. I am 
not here to speak of a few selected protected 
lives, the little class in our community which has 
grown up under very favorable conditions, but 
of the population at large, including our girls and 
women to the number of three quarters of a 
million. These girls and women know this sub- 
ject. Even those girls and women who seem to 
be too sheltered to have such information are well 
posted with such information as can be given 
them from their acquaintances and obtained from 
the conditions of life under which they live. 
They are constant learners of falsehood and of 
statements which are debasing and degrading, 
and which vitiate for them that which should be 
pure and beautiful. . . . 

"Wherever I have come close to the sufferers 
through ignorance of the facts concerning social 
disease there has been a demand that the facts be 



SEXUAL EDUCATION 39 

furnished. One young girl about to become a 
mother, who came to us very recently, when told 
the facts as we were able to give them to her, 
said, 'Go tell other girls/ and this was her con- 
stant cry throughout her illness. " 

A Mother's Responsibility. 

Speaking from the standpoint of the mother, 
a prominent woman said : "I believe the solution 
of the whole problem lies with the mothers ; that 
when they are awake to their duty and respon- 
sibility, are ready to put aside their mawkish sen- 
sibility and silly reticence and treat the laws of 
God and Nature with honesty and innocent 
simplicity, they will soon find themselves in 
control of the social evil and all that the term 
implies. The outcome rests in the mother's train- 
ing of her boys, but no less in her enlightenment 
of her girls. The girls of naturally impure ten- 
dencies, of whom there are but few, should, of 
course, be warned of the evils lurking to ensnare 
them, but no less should the girls that are inno- 
cent and pure. The great industrial revolution 
has affected the community nowhere so much as 
in the daily life of young girls. They are thrown 
out of the home by hundreds, thousands, and 
subjected to most subtle temptations, often from 



40 SEXUAL EDUCATION 

those who should have guarded their innocence. 
The mother of fifty years ago might be pardoned 
if she did not tell her daughters of the evil which 
is in the world, because life was domestic and 
shielded. The reticence of the mother to-day is 
worse than inanity — it is crime." 

Teaching the Young. 
Rev. Floyd W. Tomkins, D.D., in the same 
discussion remarked : "There is no question but 
that we have been afraid, and the result of our 
fear has been spreading sorrow. Why may we 
not have our women teaching the young women 
and girls whom they meet? Why may we not 
have teachers calling their girls together in their 
homes? Why may we not have ministers even 
from time to time organizing classes taught by 
some woman physician? And, above all, dear 
friends, why may we not have the teaching in 
the public schools embody this matter, with 
women physicians for girls, and men physicians 
for boys, teaching them concerning these things 
which must be known if we are going to save 
the future generation?" 

Solitary Vice. 

There is still another danger from which the 
girl must be protected — the habit of solitary vice. 



SEXUAL EDUCATION 41 

Failure to warn the child of this is usually due to 
the parent's fear of suggesting something of 
which the child may have no previous knowledge. 
Few realize how prevalent is this evil, and how 
many the opportunities for learning of it. 
Schools, particularly boarding schools, have long 
been the chief breeding places for bad habits. A 
servant, and especially the nurse, is frequently 
the instructor. A child may accidentally produce 
a pleasurable sensation and voluntarily repeat it 
without being aware that she is doing wrong. 
This is especially liable to occur in the presence 
of uncleanliness, or of chafing, or of irritation 
due to seat worms or some other cause, or of any 
physical defect. Children can dissemble so skil- 
fully that they may never be suspected. It is an 
injustice to the child not to warn her of the pitfalls 
into which she may stumble. Perfect frankness 
regarding so frequent a cause of general ill-health, 
chronic invalidism, and sometimes even insanity, 
will save a girl much physical and mental suffer- 
ing as well as moral loss. Even though the 
results may not be as grave and irremedial as is 
often thought, they are serious and often lasting. 
Exercise in the fresh air, proper food, the daily 
bath, are all factors in both the prevention and 
cure of this unfortunate habit. 



CHAPTER VI. 



THE MONTHLY PHENOMENA. 

Ovulation. The Physiology of Menstruation. The Menstrual 
Flow. Other Menstrual Symptoms. The Hygiene of 
Menstruation. 

Ovulation. 

The ovary has been described as a gland se- 
creting eggs. These eggs or ova develop one at 
a time. At regular intervals the most mature 
egg or ovum swells to the size of a pea and bursts 
through the wall of the ovary. This occurrence 
is known as ovulation, and takes place once a 
month during the period from puberty to the 
menopause. This period lasts on the average 
from the fourteenth to the forty-fifth year, al- 
though it has begun as early as the ninth and has 
ended as late as the fifty-ninth year. When the 
ovum is discharged from the ovary, it enters the 
funnel-shaped outer end of the Fallopian tube 
and travels through this tube into the uterus, the 
passage probably taking about a week. 
(42) 



THE MONTHLY PHENOMENA 43 

The Physiology of Menstruation. 

About the same time the ovum is discharged, 
a change takes place in the lining membrane of 
the womb, which becomes swollen and congested, 
due to an increase in the number and size of the 
blood-vessels. 

If the ovum, in its journey through the tube, 
should be impregnated by a spermatozoon or 
male cell, which has worked its way up from the 
vagina, it becomes attached to the wall of the 
uterus. When this occurs the swollen and con- 
gested mucous membrane continues to develop 
and helps to form the coverings for the ovum or 
egg with its contained embryo or unborn child. 
If, on the other hand, the ovum is not impreg- 
nated, the new and dilated blood-vessels rupture, 
filling the uterus with blood. The uterus there- 
upon contracts and expels the blood. This 
monthly discharge of blood from the womb is 
known as menstruation. 

The onset of menstruation is the principal 
event of puberty. It begins in this country at the 
fourteenth year, the time of its first appearance 
being influenced by the factors already men- 
tioned. The menstrual flow usually ceases about 
the forty-fifth year, but it may stop before a 
woman is forty. On the other hand, it often 



44 THE MONTHLY PHENOMENA 

continues beyond the forty-fifth year. The 
period at which it ceases is known as the meno- 
pause or "change of life." 

The Menstrual Flow, 

The menstrual discharge at the beginning con- 
sists of the mucous secretion from the glands of 
the uterus and vagina, streaked with blood. As 
menstruation becomes established, the flow is 
composed of pure blood mixed with a little 
mucus and some cells. With the subsidence of 
the flow, the blood diminishes and the mucus is 
increased. The discharge is dark in color. As 
a rule it does not clot. A peculiar odor is im- 
parted to it by the secretions of the glands of 
the vagina. 

The normal duration of the flow is from two 
to six days. It rarely is less than three days. 
The length of the menstrual period varies in dif- 
ferent persons. That duration which is habitual 
in an individual woman becomes the normal for 
her and usually remains unchanged throughout 
her menstrual life. 

The amount of fluid discharged varies from 
two to eight ounces. It is seldom measured 
accurately. Instead, it usually is estimated by 
the number of napkins worn in twenty- four 



THE MONTHLY PHENOMENA 45 

hours and is considered excessive if the napkins 
must be changed more than three times a day. 
The flow is greatest during the first two days and 
then grows gradually less until it ceases. After 
the first few months a standard becomes fixed for 
each individual, from which variations seldom 
occur. 

Other Menstrual Symptoms. 

At the time of the menstrual period, frequently 
preceding the flow by a few hours or a few days, 
a woman experiences a feeling of weight and 
heaviness in the generative organs, caused by 
their congestion and swelling, which amounts 
often to pain and extends through the back and 
thighs. There is also a state of more or less 
nervous excitability, depending upon the woman's 
temperament. A nervous person, as a rule, is 
made worse at such a time. The breasts usually 
swell and may even secrete milk. The neck be- 
comes enlarged through the swelling of a gland 
that lies just above the breast bone. Sometimes 
the tonsils also become swollen ; a singer may thus 
lose her voice at such times. The heart usually 
beats more quickly and forcibly. The skin be- 
comes redder from an increase of blood and may 
occasionally be flushed. Dark rings appear un- 



46 THE MONTHLY PHENOMENA 

der the eyes and brown patches, known as liver 
spots, may show upon the skin. Even eczema 
and pimples have appeared or have been made 
worse. Headache, depression, and disinclination 
to exertion are common symptoms. Pains in the 
joints and eye strain frequently occur. Any suf- 
fering to which a person is subject is usually 
aggravated at such a time. Severe pain is an 
indication that there is something wrong with 
the general health or with the local condition. 
The symptoms in some cases are relieved by the 
establishment of the flow, in others they are 
increased by it. 

Twenty-eight days usually elapse from the be- 
ginning of one menstrual period to the begin- 
ning of another. The menstrual interval, how- 
ever, may vary within the limits of health. Ir- 
regularities often occur when the general health 
is poor and when certain diseased conditions are 
present. The interval between the periods may 
be irregular for a little while after the first occur- 
rence of menstruation, and even later it may be a 
day or two longer or shorter than usual. 

The Hygiene of Menstruation. 

A healthy girl or woman need make no change 
in her normal hygienic habits during the men- 



THE MONTHLY PHENOMENA 47 

strual period. As at other times, she should 
bathe daily, but may substitute a cold rub for the 
cold plunge bath. The underclothing, of course, 
are to be removed at night as usual, despite a 
common ignorant notion to the contrary. 

Rest during menstruation is neither necessary 
nor desirable in healthy persons. It may even 
prove harmful by directing attention to the pelvic 
organs and through mental influence producing 
congestion there and accentuating all the symp- 
toms that commonly occur at such times. 
Women in poor health, on the other hand, espe- 
cially when nervous and subject to mental dis- 
turbances, often do require rest and quiet while 
menstruating, sometimes in bed. It is always 
unwise, however, to indulge in excessive exercise. 
A woman must be careful during this period to 
avoid heavy lifting, over-fatigue in walking, too 
long standing, riding a horse or wheel, dancing, 
and participating in violent sports. 

In regard to the mental and nervous symptoms 
that may occur at such a time, Dr. Walker gives 
the following excellent advice: 

"Watch yourself carefully during these periods, 
and if you observe that you are unusually irrita- 
ble, keep a tighter grasp on your self-control and 
try to appreciate the fact that you are not quite 



48 THE MONTHLY PHENOMENA 

your best self. If the world looks dark and peo- 
ple appear unfriendly, remember that you are 
being influenced by your physical condition, and 
do not pass judgment until you are feeling more 
nearly normal. You will then generally find that 
the world is just as bright and your friends are 
just as loyal as you had believed them before." 



CHAPTER VII. 



THE DISORDERS OF MENSTRUATION. 

Causes, Symptoms and Treatment of Absent Menstruation. 
Sudden Checking of the Menstrual Flow. Scanty 
Menstrual Flow. Profuse Menstrual Discharge, or 
Flooding. Two Alternatives. Vicarious Menstruation. 
Dysmenorrhea or Painful Menstruation: Causes; 
Treatment Management During the Period. 

In addition to the slight disturbances that fre- 
quently occur during menstruation, certain 
abnormalities are not infrequently encountered. 
Menstruation may be absent or irregular in its 
appearance. The flow sometimes is scanty, at 
other times profuse, and it may be accompanied 
or preceded by pain. 

Causes of Absent Menstruation. 

Menstruation has been absent in the sense that 
it has never appeared. In other cases it is merely 
suppressed. A number of conditions in the 
woman herself and in her environment may be 
responsible. Almost all cases are caused by phys- 

4 (49) 



50 THE DISORDERS OF MENSTRUATION 

ical or mental overwork and insufficiency of 
food. Absent and suppressed menstruation are 
quite commonly seen in studious school girls who 
devote too much time to their books and not 
enough to exercise in the open air; the latter is 
not rare in shop girls who take insufficient food 
that they may be able to appear in better clothes 
than their small wages would ordinarily allow. 

Suppression often results from changes of cli- 
mate and is experienced by immigrants for some 
time after their arrival. It may also be brought 
about by change of surroundings, as when a 
woman moves from the country to a large city, 
and it may continue until she has become 
accustomed to her new environment. 

Menstruation may never occur in the presence 
of a defect of development in the organs of gen- 
eration, an exceedingly rare condition. When 
after labor the womb contracts to a size much 
below the normal, as sometimes, though rarely, 
occurs, the menstrual flow may fail to reappear. 
The monthly sickness may be suppressed should 
disease or injury be present in any of the female 
organs. 

In the acute general diseases, such as typhoid 
fever, menstruation is often absent and may re- 
turn only after convalescence, with full restora- 



THE DISORDERS OF MENSTRUATION 51 



tion of the general health. The menses are also 
frequently suppressed in chronic general diseases, 
especially in those associated with debility, such 
as chlorosis, anemia, malaria and consumption. 
An excessive development of fat may prevent the 
flow appearing even in persons whose general 
health appears to be excellent. Absence of the 
menstrual function is a frequent accompaniment 
of mental disturbance, occurring quite commonly 
in insanity and being often produced by fright, 
grief or anxiety. 

Rare cases have been known of women who 
were apparently in perfect general health and 
whose sexual organs seemed to be well developed 
but who never had menstruated. 
t 
Symptoms Accompanying Absent Menstruation. 

Menstruation may be absent without causing 
the slightest inconvenience. On the other hand, 
there may be present at the menstrual period a 
feeling of general disturbance with headache, 
flashes of heat, nervousness, nausea and vomit- 
ing, and a sense of fullness and pain in the pelvis. 
In some cases various eruptions on the skin have 
been noticed. 

The most common symptom associated with 
this condition is poor health, both mental and 



52 THE DISORDERS OF MENSTRUATION 

physical This, as has been shown, although fre- 
quently regarded as the result of the suppression, 
is usually really the cause of it. 

The mother is often alarmed when the men- 
struation is delayed, and may try various home 
remedies to bring it on. The non-appearance of 
this phenomenon need not be a matter of concern, 
provided the general health is otherwise good. 
No medicine should be given for the purpose of 
bringing on the monthly sickness. Let the girl 
have plenty of good, nourishing food, sunlight, 
fresh air and out-door exercise. In time every- 
thing will probably be all right. 

Treatment of Absent Menstruation. 

If, however, the girl seems in poor health, or 
if she suffers much from pain, headache, nerv- 
ousness and general discomfort, she should be 
taken to the family physician. The services of a 
gynecologist or specialist in women's diseases are 
almost never required. The fault seldom lies 
with the generative organs; it is unwise, more- 
over, to call attention to them. A modest young 
girl ought never be subjected to an internal ex- 
amination, even by a female physician, unless 
there is ground for suspecting something serious 
to be the matter. The mere fact of menstruation 



THE DISORDERS OF MENSTRUATION 53 

being delayed is not sufficient cause. Should the 
menstruation fail to appear, however, an ex- 
amination and possibly an operation may be 
necessary. 

The special treatment in each case will depend 
altogether upon the cause and will be outlined by 
the family physician, who should always be 
consulted. 

Almost every case will require treatment di- 
rected to the improvement of the general bodily 
health. It is essential that the girl or woman 
live in strict accordance with hygienic rules. She 
should exercise in the open air, and in fact spend 
as much of her time as possible in the fresh air 
and in the sunshine. This is especially necessary 
in the case of overworked school girls, who must 
be made to apply themselves less closely to their 
studies. Every morning a cold hygienic bath 
should be taken. Sea-bathing and a change of 
climate and surroundings are beneficial. The girl 
requires nourishing food and must avoid consti- 
pation. The physician in charge may in addition 
prescribe one of a number of medicinal remedies. 

Sudden Checking of the Menstrual Flow. 

During menstruation the flow may be suddenly 
suppressed. Such an occurrence may follow an 



54 THE DISORDERS OF MENSTRUATION 

exposure to cold or an unexpected emotional dis- 
turbance. It may or may not be associated with 
pain, but is liable to cause the patient trouble. 

When the menses are suddenly checked, the 
girl should be given a hot tub, hip or foot bath 
and be put to bed under warm covers, with hot 
water bottles about the body and with cloths 
wrung out of hot water applied to the lower 
abdomen. At the following menstrual period the 
strictest hygienic precautions should be observed. 

Scanty Menstrual Flow. 

A menstrual flow much less than normal may 
be due to one of the conditions that have been 
mentioned as giving rise to absent or suppressed 
menstruation. When this is the case the treat- 
ment is the same as that described in the pre- 
ceding pages. 

It must be borne in mind, however, that cer- 
tain women may have individual peculiarities in 
this respect without departing from the limits 
of health. 

Profuse Menstrual Discharge, or Flooding. 

The presence of flooding or of excessive men- 
strual bleeding is a much more significant condi- 
tion than absence or suppression of menstruation, 



THE DISORDERS OF MENSTRUATION 55 

and it usually indicates a more serious state of 
affairs. Many diseases of the female generative 
organs have as a prominent symptom an increase 
in the duration and amount of the menstrual flow. 
An enumeration of these many and varied dis- 
eases would serve no useful purpose and would 
only tend to alarm unnecessarily any woman who 
imagined that her periods were unduly prolonged. 
It is a matter solely for the physician, who should 
be consulted at once. 

The amount of blood lost during menstruation 
varies in different individuals. Each woman soon 
recognizes what her normal is, which she can 
bear without discomfort or impairment of health. 
When two or three times the usual amount of 
blood is lost an abnormal condition is present, 
demanding attention. In such a case the blood 
usually comes away in spurts or gushes, being 
bright red instead of dark, or it may form clots 
in the vagina, which are discharged from time 
to time. The bleeding is always increased when 
the woman stands or moves about. The flow 
may be excessive throughout the period, it may 
be unduly prolonged beyond its normal limits, 
or it may be both excessive and prolonged. The 
woman's health is usually affected with resulting 
pallor, shortness of breath and general debility. 



56 THE DISORDERS OF MENSTRUATION 

Two Alternatives. 

If the bleeding is really excessive, there are 
two things a woman can do — one dangerous, the 
other safe. If a woman wants to tinker with her 
life and her health, she can take any one of the 
many worthless patent medicines that the mis- 
leading advertisements guarantee to cure condi- 
tions which she imagines are exactly like hers. If 
she takes these alcoholic beverages long enough 
she may delay applying for proper relief until the 
condition is past all cure. 

The only safe thing for a woman to do when 
she notices excessive bleeding is to immediately 
consult a reliable physician. Doctors who adver- 
tise are as dangerous as the advertised medicines. 

Vicarious Menstruation.] 

The term, vicarious menstruation, is applied to 
the discharge of blood at the menstrual period 
from some part of the body other than the uterus. 
This bleeding may come from the nose, the 
throat, the lungs, the stomach, the bladder, or 
the rectum. It may occur in addition to the nor- 
mal flow. It is a rare condition, though, as a 
rule, of no serious import, being usually found 
in debilitated, nervous women. In some cases, 
however, it is indicative of defective development. 



THE DISORDERS OF MENSTRUATION 57 

The treatment of vicarious menstruation is en- 
tirely hygienic, directed to the improvement of 
the general health. A physician should be con- 
sulted to find out if any physical defect or local 
disease is present. 

A woman must never take it upon herself to 
decide that a hemorrhage or bleeding is due to 
vicarious menstruation. 

Dysmenorrhea, or Painful Menstruation. 

A certain amount of pain and discomfort and 
other local and general disturbances may accom- 
pany normal menstruation, as has been described 
in the preceding chapter. More than this is ab- 
normal. When the symptoms are increased, the 
pelvic pains may begin from one to two days to 
a week before the appearance of the flow. They 
are of a dull, dragging character, extending all 
through the back and down the thighs, often 
accompanied by severe headache, and occasionally 
associated with nausea, extreme lassitude and 
nervous excitability. They may be greatly re- 
lieved by the establishment of the flow, or they 
may continue throughout its duration. In some 
cases the suffering is not only more severe than 
that found normally, but is of a different char- 
acter; the pain beginning just before, or exactly 



58 THE DISORDERS OF MENSTRUATION 

i * 

with, the appearance of menstruation, being 
sharp, well-defined, and cramp-like, and coming 
on in brief, frequently recurring, paroxysms, 
while the general symptoms are less marked. 

The Causes of Painful Menstruation. 

Pain occurs at the time of the menstrual period 
in the conditions called anemia and chlorosis, 
which are associated with impoverished blood. It 
is common in young girls under twenty years of 
age and is sometimes seen in young married 
women. Its chief causes are poor hygienic sur- 
roundings, overstrain caused by the perpetual 
rush and excitement of constant social engage- 
ments and consequent appointments with milli- 
ners and dressmakers, and too close application to 
studies. Painful menstruation is often due to an 
obstruction to the flow of blood produced by a 
bending forward of the uterus or of its neck, or 
by a stiffness of the neck of the womb, which 
prevents its opening, or by some other mechanical 
obstacle. Mal-development and disease of the 
reproductive organs are other causes. In neuras- 
thenia menstruation is often accompanied by 
severe pain and other disturbances having no 
anatomic basis, but being merely part of the 
nervous condition. 



THE DISORDERS OF MENSTRUATION 59 

-. 

Treatment of Dysmenorrhea. 

When painful menstruation is due to inflamma- 
tory disease or to a bend in the womb, it is seldom 
outgrown. On the contrary, if not relieved, the 
suffering tends rather to increase. The proper 
methods of treatment in this condition will be 
prescribed in each case by the attending physician. 

When the pain experienced at the monthly 
period is due to an impoverished condition of the 
blood or to a lowering of the general health, 
hygienic treatment is indicated. In many cases it 
alone will effect a cure. Before a young unmar- 
ried woman is subjected to a local examination 
(except in the presence of inflammation) she 
should conscientiously carry out such general 
measures over a long period of time. In most 
cases the suffering will thereby be relieved. Of 
course the treatment — even when only hygienic — 
should be under the physician's directions. If the 
severity and persistence of the symptoms demand 
it, an internal examination is justifiable, but in a 
virgin it is best made under an anesthetic. A 
simple operation may be found necessary. A 
course of local treatment, however, in a young, 
unmarried woman is decidedly objectionable and 
seldom necessary. 

Fresh air, sufficient nutritive food, proper bath- 



60 THE DISORDERS OF MENSTRUATION 

ing, daily exercise, at least eight hours' sleep at 
night and a nap in the afternoon, if possible, 
avoidance of late hours, of excitement, of over- 
exertion and of constipation, will usually prove 
sufficient to bring about a normal condition of 
affairs. 

Management During the Period. 

Rest is the most essential remedy for painful 
menstruation. Absolute rest in bed for two or 
three days at each period is necessary, beginning 
if possible before the appearance of the flow. 
This may often be discontinued after some 
months, but in other cases one must rest in bed 
each time for at least the first twenty-four hours. 

A girl suffering from this condition should 
remain home from school during her menstrual 
period. 

Pain during menstruation is often relieved by 
the application of heat externally in the form of 
hot water bags or hot sand bags. Benefit some- 
times results from a hot mustard foot bath, made 
by putting two teaspoonfuls of mustard in a 
foot- tub full of water as hot as can be borne and 
kept hot by the constant addition of very hot 
water. In some cases a hot drink following the 
foot bath proves efficacious. A hot mustard 



THE DISORDERS OF MENSTRUATION 61 

plaster applied along the spine for from ten to 
twenty minutes may be of service. 

Drugs are sometimes given by the attending 
physician. Alcoholic stimulants, such as gin, 
whiskey and the various patent medicines, should 
be avoided. They may work serious injury. 



CHAPTER VIIL 



THE MENOPAUSE. 

Age at Which the Menopause Occurs. Physiology of the 
Climacteric. Symptoms of the Menopause. Danger 
Signals. Hygiene of the Menopause. 

The period during which a woman experiences 
the monthly sickness lasts on the average about 
thirty-four years. The final cessation of men- 
struation is spoken of as the menopause, climac- 
teric, or "change of life. ,, 

Age at Which the Menopause Occurs. 

In this country the menopause occurs, as a 
rule, anywhere between the ages of forty and 
fifty-five, the majority being between the forty- 
fifth and fiftieth year. The age depends upon 
various conditions. When menstruation begins 
early it usually ends late, and when it begins late, 
ends early. It may appear prematurely in very 
fat women, in those suffering from consumption, 
Bright's disease, or diabetes, and in women who 
(62) 



THE MENOPAUSE 63 

have borne a large number of children in rapid 
succession and have suckled them. It may be re- 
tarded in the presence of disease of the womb, 
tubes or ovaries, especially when there is a fibroid 
tumor of the uterus. "Change of life" appears 
later in the northern part of Europe than in the 
southern, in England than in America, in 
country than in city residents, and among the idle 
and well-to-do than among the laboring classes. 

Physiology of the Climacteric. 

All the organs of generation become smaller at 
the climacteric and gradually cease functionating. 
Many of the disagreeable sensations experienced 
at this period are due to the absence in the blood 
of the product secreted by the ovaries. Shrinking 
occurs in external as well as in internal organs, 
shown by wasting of the breasts. 

The mode of onset of the menopause varies. 
In the majority of cases the amount of blood 
passed at each monthly period becomes gradually 
diminished until it ceases altogether. In 
other cases the menstrual flow stops abruptly and 
permanently. Sometimes one or more periods 
are skipped, after which the flow again occurs, 
perhaps with a lessened amount, followed by 
more irregularity and then by the final cessation. 



64 THE MENOPAUSE 

Symptoms of the Menopause. 

If the woman's general health is good, and if 
there is no disease of any kind, the menopause 
may be ushered in with no more symptoms than 
those already noted. No marked general disturb- 
ance is present in such a case. Many women, 
however, suffer from very annoying conditions 
for one or two years. Headache is a common 
symptom. Hot flushes may occur frequently 
throughout the day, sometimes as often as sev- 
eral times within an hour. They consist of a 
feeling of heat over the whole body or over a 
part, followed by sweating and a cold, chilly 
sensation. Palpitation of the heart is experienced 
in many instances. The digestive apparatus often 
gets out of order. Large accumulations of fat 
may develop. There is sometimes a marked de- 
rangement of the nervous system at this period, 
affecting occasionally even the mental condition. 
The woman may exhibit slight vagaries, a loss 
of interest in the daily affairs of life, and in 
extreme cases even melancholia and other forms 
of insanity. 

Danger Signals 

It is a great mistake, however, to ascribe all 
disturbances occurring at middle life to the meno- 



THE MENOPAUSE 65 

pause. Many serious conditions have been over- 
looked by such superficial observation. Every 
symptom complained of should be investigated 
just as thoroughly as at any other age. 

Owing to her ignorance as to what constitutes 
the normal occurrences to be expected at the 
menopause, a woman usually is unable to recog- 
nize dangerous symptoms when they appear. 
Every year many women lose their lives in con- 
sequence of this ignorance. They view the dan- 
ger signals with complacency, regarding the 
warnings as part of the normal phenomena of the 
climacteric. It is, therefore, most important for 
every woman who has reached her fortieth year 
to acquaint herself with the normal symptoms 
that accompany "change of life^ and to be able 
to recognize the symptoms of disease that fre- 
quently occur at the same time. 

When diseased conditions are present, Nature 
gives certain warnings which must be regarded if 
the disease is to be checked in time. The follow- 
ing phenomena are not normal : ( I ) Profuse 
bleeding at the time of the menopause; (2) Slight 
bleeding occurring oftener than once in four 
weeks; (3) The apparent reappearance of men- 
struation or of slight irregular hemorrhages 
after the menopause has been established and 



THE MENOPAUSE 



menstruation has been absent perhaps for many 
months; (4) The appearance of watery, irritat- 
ing or rust-colored discharges. 

Such symptoms occurring in women over 
thirty-five, and particularly between forty and 
forty-five years of age, should always be viewed 
with alarm. When they occur, a woman should 
immediately consult her physician. Any bleeding 
from the vagina in a woman who has passed the 
menopause should arouse the gravest suspicion. 
It is often caused by a tumor of some sort. If 
the tumor be a fungous growth, a polyp, or a 
fibroid, the condition may not be so serious as if 
it be a cancer. In the latter instance, delay in 
seeking medical advice usually means death, 
while promptness may result in a cure. Professor 
Penrose says of cancer of the cervix that "in the 
early stages the disease may be eradicated with 
every probability of a permanent cure," but that 
"the great majority of women come to the opera- 
tor when the disease has extended too far to 
permit any radical treatment." 

Hygiene of the Menopause. 

A woman entering upon the "change of life" 
would do well to carefully observe the rules of 
hygiene. It is most important that the general 



THE MENOPAUSE 67 

bodily health be maintained. Frequent warm 
baths are required to keep the skin acting well. 
The diet should be simple and unirritating, with 
restriction of meats and an increase in the amount 
of vegetables eaten. Sugar is apt to set up a fer- 
mentation in the stomach; consequently sweet 
dishes, such as cakes, candies, preserves, jellies 
and sweet puddings must be taken in modera- 
tion, and when indigestion is present, avoided 
altogether. The woman will also have to refrain 
from eating pastry, hot breads, fried food and 
rich dishes. She should drink water freely, 
taking three pints a day if possible. Stimulants 
are to be avoided, alcohol in any form being pro- 
hibited. It is necessary to keep the bowels open 
by taking suitable food and exercise, or by means 
of purgatives or laxatives when required. There 
is decided advantage in an outdoor life and in 
gentle exercise in the open air. Massage is 
beneficial, especially to those who for any reason 
are unable to take active exercise. It may be 
given twice a week by a skilful masseuse. 

The Turkish bath is an excellent form of exer- 
cise, combining the effects of massage and of the 
hot bath. It is particularly useful at this period, 
distributing the blood throughout the body and 
aiding the skin in getting rid of waste matters. 



68 THE MENOPAUSE 

It must not be taken, however, without the phy- 
sician's permission or advice. 

The nervous system also demands attention. 
Domestic burdens should be lightened and the 
woman relieved of worry and responsibility as 
much as possible, though not left without con- 
genial occupation. It is well to provide some 
form of amusement. A change of locality and 
surroundings is sometimes required. In certain 
cases it may be even necessary to resort to the 
rest-cure. 



CHAPTER IX. 



THE CRUSADE AGAINST CANCER. 

How Cancer Grows. The Danger of Delay. The Parts 
Usually Attacked. Warning Symptoms. Proper and 
Improper Treatment. A Yearly Examination. 

The spread of cancer during the last quarter of 
a century has been one of the most alarming sit- 
uations with which the medical profession has 
had to cope. In some sections of Pennsylvania 
cancer kills as many persons as tuberculosis. It 
is believed that if the people will work with the 
physicians, the spread of cancer can be checked. 
In the great majority of cases the disease is abso- 
lutely curable in its early stages. 

In order that the public should understand this, 
and that each case should be recognized at the 
earliest possible moment, national and state med- 
ical societies have appointed committees to in- 
struct the public. The following is part of 
the public announcement of the Pennsylvania 
physicians : 

(69) 



70 THE CRUSADE AGAINST CANCER 

Science has not yet ascertained the first causes 
of cancer. But constant study of it has enabled 
the medical profession to recognize some of the 
things that invite and encourage it. It is also 
known to a certainty that in its early stages cancer 
is a local disease, and that if it is quickly removed 
an absolute cure is effected. 

How Cancer Grows. 

Cancer usually makes its appearance in some 
part of the body accessible to the surgeon. When 
once it has started, it has never been known to 
subside of itself. 

If it is permitted to grow, it not only spreads 
on the surface and sends its roots deeper into the 
flesh, but little particles of the tumor are carried 
by the blood to lodge in other parts of the body. 
These particles act as seeds, take root and grow 
new cancers. The lungs, liver or other organs 
catch these seeds from the blood. 

This explains the vital importance of cutting 
out the first cancer in the earliest stages. 

To secure this early surgical treatment, it is 
necessary that the public should be watchful for 
the appearance of cancer and quick to recognize 
the symptoms when they do appear. Then a 
reputable physician should be consulted at once. 



THE CRUSADE AGAINST CANCER 71 

Cancer is a malignant tumor, which may begin 
in any tissue, but which frequently originates in 
the skin or mucous membrane, and then should be 
readily recognized by a layman. At first the mass 
is hardly visible to the naked eye. After a short 
time, if the growth is near the surface — where it 
nearly always is — it can be easily seen or felt. It 
may be mistaken for a wart or mole. A wart or 
mole that continues to grow demands the atten- 
tion of a surgeon. It may be cancerous. How- 
ever, the layman should never decide for himself 
on this point. The doctor should be consulted 
without delay. 

If the growth becomes ulcerated it is almost a 
sure sign of beginning cancer. Up to this time 
the cure is not only certain, but easy. It is simply 
a matter of cutting out the tumor before it has 
spread to important structures in its vicinity, and 
before it has sent out its seeds to become internal 
cancers. The longer the delay, the more danger- 
ous is the operation and the more likelihood that 
malignant tumors will occur in other parts of 
the body. 

The Danger of Delay, 

The growth of cancer may be almost definitely 
divided into two periods; the first in which the 



72 THE CRUSADE AGAINST CANCER 

cure is simple and virtually sure, and the second, 
after it has spread to such an extent as to make 
the treatment difficult and the cure improbable. 
If neglected for a sufficiently long period, the 
cancer will reach a stage in which it cannot be 
cured by any method now known to the medical 
profession. 

The point to be emphasized more than any 
other is that as soon as a malignant growth makes 
its appearance, be it ever so small, it should 
receive the attention of a reputable physician. 
There should be no waiting to see if it increases 
in size, no timidity, no making light of it. If it 
is cancerous, prompt action will probably save the 
life of the patient. 

The Parts Usually Attacked. 

Cancer is most frequently a disease of adults, 
but it may occur at any time of life. The most 
susceptible period begins at thirty-five years and 
increases until forty-five. From that age until 
fifty the tendency to cancer is greatest. 

It is slightly more common in women than in 
men. In women the uterus, the breast and the 
skin are affected in the order named. In men the 
skin, the tongue, the mouth, the lip and the 
stomach are most commonly affected. 



THE CRUSADE AGAINST CANCER 73 

Other organs may be attacked in either sex, 
though with less frequency. 

So far as now known, cancer is not inherited. 

In very rare cases cancer has followed an 
injury from a single blow. But it is frequently 
the consequence of repeated slight injuries or 
irritation. Chronic inflammatory conditions due 
to such irritation may easily be the forerunner of 
true cancer. The repeated irritation of a wart or 
a mole on the face by the careless use of a razor 
is a common origin of cancer. A broken tooth 
rubbing the cheek or tongue often causes a sore 
that becomes cancerous. 

The chronic inflammation that follows tears in 
the uterus is a constant cause of cancer in that 
organ. For this reason early repair of such 
injuries is highly important. 

Certain chronic skin diseases may develop 
cancer if they do not receive early treatment. 
Ulcers or sores of any kind in any part of the 
body, if continued unrelieved, may become cancer. 
Oftentimes such ulcers are cancerous from the 
start. 

A tumor of any kind, even a simply fatty 
tumor, may develop into cancer if allowed to 
remain. Such tumors should be removed 
promptly after being discovered. 



74 THE CRUSADE AGAINST CANCER 

Warts and some of the large pigmented moles 
often become cancerous. This is especially true 
when they are subjected to irritation which causes 
chronic inflammation. 

Warning Symptoms, 

In some of the most prominent seats of cancer 
the danger signals are as follows : 

i. Cancer of the breast. A small hard lump in 
the breast at any age is an abnormal condition, 
and should be removed at once, as later it may 
develop into cancer. If a woman is over thirty- 
five or forty years of age when this lump is 
discovered, it is cancerous in 90 per cent, of the 
cases. Such a lump, therefore, should be removed 
at once. If one waits to see if it is going to 
grow, it will very likely develop internally, and 
after a few months will be beyond reach of any 
treatment. 

2. Cancer of the uterus. The danger signal 
here is slight bleeding at irregular times after 
thirty years of age, or any bleeding after the 
change of life. The first appearance of such 
hemorrhage should lead at once to a thorough 
investigation of the cause. It may happen that 
the warning may not be repeated until the 
advanced incurable stage is reached. Any dis- 



THE CRUSADE AGAINST CANCER 75 

charge of bad odor in a woman over thirty years 
of age should have the attention of a physician. 

3. Cancer of the lip, tongue or month. Here 
the danger signal is a wart or mole of any kind 
that will not heal. If such a condition first 
appears in the lip, mouth or tongue of a person 
over forty years old it is practically certain to be 
cancerous. 

4. Cancer of the skin. Here, too, the danger 
signal is a sore of any kind which does not readily 
heal. It is always suspicious if a wart or mole 
which has been present for a long time suddenly 
begins to grow. 

5. Cancer of the stomach and alimentary canal 
Here the danger signals are less evident. The 
presence of obstinate indigestion, loss of flesh, 
strength and appetite, persistent colicky pains in. 
the abdomen, obstinate constipation or diarrhea, 
the vomiting of blood, or blood in the stools, are 
all signals of the gravest danger and must at once 
be investigated. This is especially true if the 
person is over forty years. 

In the stomach an ulcer or some other simple 
condition may be present for a long time and 
later develop into cancer. When this change 
occurs there will be a marked increase in all the 
symptoms. Any serious digestive troubles in 



76 THE CRUSADE AGAINST CANCER 

middle life should receive prompt attention. If 
they do not yield readily to medical treatment, 
the question of cancer is at once raised and should 
be thoroughly investigated. 

It is of first importance that people should 
know that in the early stages of cancer there is 
no pain and no impairment of general health. 
Every physician of experience has patients who 
come to him with advanced cancer and say that 
they received the warning signal months before, 
but did not pay any attention to it, because they 
experienced no pain and felt perfectly well. They 
ignored the danger until too late for help. 

Proper and Improper Treatment. 

A special warning is necessary against patent 
and secret processes applied by certain quacks in 
so-called "cancer institutes/' These are not only 
useless, but often actively harmful, aggravating 
the tumor and increasing its growth. 

In general, the only efficacious treatment for 
cancer is the complete surgical removal of the 
diseased tissues. A few exceptional cases are 
amenable to X-ray under the direction of a recog- 
nized and skilful expert. But these cases are so 
few as not to concern the public or the general 
practitioner. 



THE CRUSADE AGAINST CANCER 77 

The one safe and reasonably reliable cure for 
cancer is the surgeon's knife, properly applied in 
the early stage. 

Four out of five cancers develop in parts of the 
body easily accessible to surgery. They usually 
give ample warning of their presence, so that 
treatment may be applied during the curable stage. 

In scores of laboratories all over the country 
there is a tireless search being pushed to find some 
other cure for cancer. When it has been found 
the medical profession will be the most eager to 
welcome and use it. 

But at present two points strongly urged are: 

First, that the public should be on the watch 
for warnings or symptoms of cancer, that they 
may be detected in the earliest possible stage. 
And, secondly, that the cancerous growth be 
immediately cut out by a competent and recog- 
nized surgeon. 

Perfect co-operation of public and physicians, 
in this respect, will reduce the death rate from 
cancer to a minimum, and render what is now a 
dreadful scourge a comparatively simple malady. 

A Yearly Examination. 

Professor Howard A. Kelly, of Johns Hopkins 
University, urges as a measure in the warfare 



78 THE CRUSADE AGAINST CANCER 

against cancer of the womb that every woman 
who has borne children should be examined by a 
competent physician at least once every year until 
she is fifty-five years old. He believes that this 
would result in the prompt discovery of a number 
of cancer cases in their very incipiency. "That 
such a course would be distasteful to women at 
large," says Dr. Kelly, "I do not doubt, but 
drastic measures are often necessary to purge ill 
humors; and who would measure such a trifling 
sacrifice against the great gain of even a small 
increase in the percentage operability of this 
distressing and to-day largely hopeless class of 
cases ?" 



CHAPTER X. 



THE GUARANTEE OF SAFETY IN THE 
MARRIAGE CONTRACT. 

Preventing the Marriage of the Unfit. Infection through 
Marriage. The Distribution of Literature. Present- 
ing the Facts. 

Among the laws of Indiana concerning mar- 
riage occurs the following clause : 

"No license to marry shall be issued when 
either of the contracting parties is an imbecile, 
epileptic, of unsound mind, or under guardianship 
as a person of unsound mind, nor to any male 
person who is or has been within five years an 
inmate of any county asylum or home for indigent 
persons, unless it satisfactorily appears that the 
cause of such condition has been removed and 
that such male applicant is able to support a family 
and likely to so continue, nor shall any license 
issue when either of the contracting parties is 
afflicted with a transmissible disease, or at the 
time of making application is under the influence 
of an intoxicating liquor or narcotic drug." 
(79) 



80 SAFETY IN THE MARRIAGE CONTRACT 

The object of such a law is to guarantee safety 
in the marriage contract and to provide for the 
health of the unborn. 

Infection Through Marriage. 

The likelihood of transmission is great when 
either husband or wife is suffering from consump- 
tion or from one of the social diseases. 

Years of treatment are required before it is safe 
for one with syphilis to marry. 

It is impossible to tell when gonorrhea is cured. 
Many cases of apparent cure are merely conditions 
of quiescence, the symptoms being absent but the 
germs still lurking about. When one but stops 
to consider that 80 per cent, of young men con- 
tract this disease, one realizes the risk run by 
every woman who enters wedlock. 

The Distribution of Literature. 

In the interest of American women and for 
their protection, the Pennsylvania Society for the 
Prevention of Social Diseases has issued a circular 
of information to insure to them : 

1. Full mental and physical health, — the birth- 
right of nature's children. 

2. Free access to facts that will guard them 



SAFETY IN THE MARRIAGE CONTRACT 81 

against ignorant error, and consequent physical 
disaster to themselves and their children. 

3. The observance of a like standard of morals 
for men and women, and the public recognition 
by society at large of nature's inexorable decree 
that physical and moral hygiene must be identical 
for the two sexes if the health and vigor of the 
nation shall continue. 

4. Full knowledge that certain diseases which 
are now recognized as factors in depopulating 
civilized nations, and are widespread in our own 
America, appear to be most certainly preventable 
by one means, the education of our women in 
demanding of their husbands, sons and friends, 
lives as clean as their own, and therefore as free 
from the likelihood of transmitting disease. 

5. And finally, the knowledge that women 
and children have suffered untold misery, and 
have been subjected to a physical blight, pitiless 
and unrelenting, as the result of an ignorance that 
has been permitted by those who should protect 
and cherish rather than destroy their homes and 
homemakers. 

Presenting the Facts, 

The following are among the facts submitted: 
That syphilis and gonorrhea, the so-called 

6 



82 SAFETY IN THE MARRIAGE CONTRACT 

venereal or social diseases, are as widespread 
throughout our civilized communities as any other 
communicable infections. 

That both diseases are acquired, by the male, 
mainly through illicit intercourse; by the female, 
largely through (on her part) innocent infection, 
carried to her by a diseased husband. 

That each of these diseases is transmissible 
throughout its course, not only through sexual 
intercourse but also by means of the discharges 
from lesions (sores) upon the fingers, the body, 
the tonsils, the lips; through the kiss, by means 
of clothing, pipes, cigarettes, and other utensils 
of daily use. 

That syphilis may be and is transmitted to chil- 
dren by either the father or mother. 

Gonorrhea may be and often is transferred 
from mother to child (usually causing an infec- 
tion of the eyes), and occasionally from child to 
nurse, relatives and friends. 

That gonorrhea and syphilis are the direct 
cause of more than one-fifth of all the blindness 
in the world. 

That many thousands of children are annually 
born diseased, dead, or doomed to death in early 
infancy, as the result of gonorrheal or syphilitic 
parentage. 



SAFETY IN THE MARRIAGE CONTRACT 83 

That more miscarriages and abortions (death 
of the child before birth) occur as the result of 
syphilis and gonorrhea than from any other 
known causes. 

That at least fifty per cent, of the sterility 
(inability to produce children) among men and 
women is due to gonorrhea or syphilis of the 
husband, usually transmitted from and by him to 
the wife. 

That many men and women remain uncured 
and infectious long after they believe themselves 
rid of the danger of transmitting disease. 

That gonorrhea is the direct cause of between 
ten and ninety per cent, (the percentage varying 
in the experience of distinguished surgeons) of all 
the abdominal operations performed upon women. 
Few women are thoroughly cured of gonorrheal 
disease. 

That exceedingly few men whose lives are 
morally unclean escape infection with gonorrhea 
or syphilis, or both, and fail to become a source 
of danger to those with whom they come in daily 
contact, and to their future children. 

That a man of confirmed drinking habits is, 
with rare exceptions, also morally and physically 
tainted, the association of dissipation with im- 
morality and its attendant venereal disease being 



84 SAFETY IN THE MARRIAGE CONTRACT 

so frequent as to constitute a warning and a 
menace. 

That the girl or woman who ignores these facts 
when choosing her male acquaintances, her 
friends, and her life partner, invites into her 
future a moral degradation, physical incapacity, 
probably the ordeal of a grave surgical operation, 
the possibility of permanently diseased children, 
or of complete sterility, and the imminent risk of 
a broken or unhappy home. 



CHAPTER XL 



PROVIDING FOR THE HEALTH OF 
THE UNBORN. 

Protecting the Children. Frankness Concerning Hereditary 
Disease. The Day of Reckoning. Where the Heredi- 
tary Taint is Slight. Drunkenness an Obstacle to 
Marriage. Insanity and Epilepsy a Bar to Marriage. 
Deaf -Mutism in its Relation to Marriage. Instinctive 
Criminality a Form of Degeneracy. Heredity Some- 
times a Factor in Consumption. The Marriage of 
Syphilitics. Consanguineous Marriages. 

Protecting the Children. 

There is another important consideration in 
marriage for which the Indiana law wisely pro- 
vides, namely, the protection of the children. As 
stated by Professor Richardson : 

"The first step toward the reduction of disease 
is, beginning at the beginning, to provide for the 
health of the unborn. The error commonly enter- 
tained, that marriageable men and women have 
nothing to consider except wealth, station or 
social relationships, demands correction. The 
offspring of marriage, the most precious of all 
(85) 



86 PROVIDING FOR HEALTH OF UNBORN 

fortunes, deserves surely as much forethought as 
is bestowed on the offspring of the lower animals. 
If the intermarriage of disease were considered 
in the same light as the intermarriage of poverty, 
the hereditary transmission of disease, the basis 
of so much misery in the world, would be at an 
end in three, or at most four, generations." 

Frankness Concerning Hereditary Disease. 

Strahan advises that all persons who contem- 
plate matrimony, or to whom attention and over- 
tures are being made with a view to marriage, 
should look upon a mutual exchange of confi- 
dences upon this matter of heredity or family 
disease as absolutely essential, and that, too, at 
an early period of the intimacy, before the affec- 
tions have become deeply engaged. Too often 
knowledge of the existence of the family skeleton, 
when given at all, is only given when matters 
have gone so far that only those of strong will 
find it possible to give up the loved one because 
of an evil so distant and shadowy as this family 
taint appears to the eyes of the lover. 

Before the marriage of a person in whose 
family there is an hereditary disease, it is well 
to consult a competent physician and lay the whole 
matter before him candidly and honestly. His 



PROVIDING FOR HEALTH OF UNBORN 87 

decision should be accepted as final. The impor- 
tance of adopting such a course cannot be empha- 
sized too strongly. 

The Day of Reckoning. 

Untold misery is entailed by the disregard of 
such precautions. The day of reckoning has thus 
been described: "In some cases it comes very 
soon, as where the first-born's vacant face is 
scanned day after day, and the heart sinks as the 
terrible fact forces itself upon the parent that his 
child is an idiot, or where the young wife sud- 
denly loses all that made her god-like, all that 
made her human, and the husband finds himself 
with a creature in his arms at w r hich his soul 
revolts. . . 

"But in many cases the evil day does not arrive 
until middle life; and then, when the fear once 
felt has worn away, when the deception practiced 
has faded from the memory, and the grave ad- 
monition of the physician is forgotten, the son in 
whom the father hoped to live again, the girl on 
whom the mother's heart is set, is torn from the 
family circle a raving maniac, a tortured epileptic, 
a drunken criminal, or, happily, a suicide. Then 
arise sad regrets, but it is too late; the laws of 
Nature have been ignored, gratification has been 



88 PROVIDING FOR HEALTH OF UNBORN 

purchased, and the price must be paid. The sins 
of the fathers shall be visited upon the children." 

When the Hereditary Taint is Slight. 

In addition to the cases in which the hereditary 
predisposition to disease is so decided that mar- 
riage should not be considered, there is a still 
larger class of those in whom the taint is so miti- 
gated that, with a properly selected partner, a 
fairly healthy family may be reared. If a member 
of a neurotic family — namely, one in which 
insanity, epilepsy, drunkenness or suicide has at 
any time appeared — marries a healthy member of 
a healthy family, the tendency to nervous disease, 
if not too deeply marked in the parent, may be 
totally lost in the children. But when he marries 
into another neurotic family disaster will surely 
fall upon the luckless children. Even when the 
disease has appeared in but one or two members 
of the family, it shows the existence of the ten- 
dency and will probably reappear in the children 
of such an unfortunate marriage. 

Drunkenness an Obstacle to Marriage. 

There is probably no disease or vice which 
causes deeper degradation in the individual and 
more acute suffering in the family than drunken- 



PROVIDING FOR HEALTH OF UNBORN 89 

ness. It is the starting point of insanity, epilepsy, 
crime, and endless diseases in posterity. 

Idiocy is often due to a family taint of drunken- 
ness, about 25 per cent, of idiots being children 
of intemperate parents. In Norway, when the 
duty on liquor was removed and intemperance at 
once began to increase among the people, idiocy 
increased 150 per cent, and insanity 50 per cent, 
among the children born during the next ten 
years. 

No woman should marry a confirmed drunkard ; 
nor should she become engaged to the son of one 
until his disposition and character have been most 
carefully inquired into. 

Insanity and Epilepsy a Bar to Marriage. 

When insanity is inherited in any family, it 
usually appears in only one, two or three mem- 
bers of each generation ; but it may be transmitted 
to the next generation by those who do not them- 
selves become insane. A person who at any time 
has been insane should never marry. A member 
of a family in which any mental disorder has 
appeared should not marry into another neurotic 
family. If, however, such a one be a man, and 
show no evidence himself of the family failing, he 
may sometimes marry into a healthy family with 



90 PROVIDING FOR HEALTH OF UNBORN 

but a minimum of danger to the offspring, 
although it were best not to run the risk of 
progeny. Such permission, however, can never 
be granted to a woman, as there are certain 
epochs in her life when the chances for losing her 
reason are very great if there be an hereditary 
taint of insanity in her family. 

Epilepsy may practically be regarded as an 
hereditary affection. Although at times it may 
seem to be brought on by injury or fright or 
nervous irritation, it seldom attacks one who does 
not inherit a neurotic temperament. In fact when 
there is insanity in a family the children are liable 
to be epileptic. Consequently one subject to this 
disorder should not marry. 

Deaf-Mutism in Its Relation to Marriage. 

There are two classes of deaf mutes which must 
be carefully differentiated before the question of 
marriage is considered. In one, family predispo- 
sition plays no part ; in the other, the disease is of 
an hereditary character. Where deafness has 
followed some injury to the organ of hearing 
before or shortly after the power of speech has 
been attained, it should not be a hindrance to 
marriage, as it is never transmitted. Deafness 
present at birth, however, is usually dependent 



PROVIDING FOR HEALTH OF UNBORN 91 

upon some family defect, being a condition of 
degeneracy closely allied to idiocy. Clouston 
considers it a physiological sin that marriage 
between such persons should be legal. 

Instinctive Criminality a Form of Degeneracy. 

The habitual criminal is an abnormal type of 
individual, the result of a family degeneracy. He 
is a moral imbecile, lacking the moral sense in the 
same manner as the idiot lacks intelligence. The 
hereditary character of this form of degeneracy, 
which is known as instinctive criminality, has 
been recognized from the earliest times. Like 
every family trait, it may be transmitted to all or 
only to some of the members of each generation. 

Of all the persons convicted of wilful murder 
in England and Wales between the years 1879 and 
1888, 32 per cent, were found insane. 

It is needless to say that a member of a degen- 
erate family should never marry and thus transmit 
the criminal tendency. 

Heredity Sometimes a Factor in Consumption. 

While consumption itself is not inherited, it 
often occurs in persons who from birth are char- 
acterized by lowered vital resistance. This condi- 
tion of inability to resist disease may be trans- 
mitted, but, as a rule, is acquired. 



92 PROVIDING FOR HEALTH OF UNBORN 

Persons who have this condition of undevelop- 
ment and lessened vital force may transmit it to 
their children. If they marry into a family with 
the same failing, this tendency in the offspring 
will be more marked. As a rule, however, by 
careful attention to the laws of hygiene, the ten- 
dency to consumption may be overcome. A person 
with such an hereditary taint, by proper living, 
may not only avoid having consumption herself, 
but may so eradicate this family failing that it 
will not appear in the children. 

The Marriage of Syphilitics. 

Syphilis is not an hereditary disease, strictly 
speaking, but it may be transmitted to the off- 
spring by either parent. A person who has once 
had this disease should not marry until a physi- 
cian has declared the disease cured and has given 
his permission for the marriage. 

The period of danger may last from two or 
three years to ten or fifteen years after the onset 
of the disease, depending upon the faithfulness 
with which the treatment has been carried out. 

Consanguineous Marriages. 

The question of consanguineous marriages is 
usually settled by the law, in many States mar- 



PROVIDING FOR HEALTH OF UNBORN 93 

riage of first cousins being forbidden. There is 
no physiological reason, however, why such mar- 
riages should not take place. A committee ap- 
pointed by the New York State Medical Society 
to investigate the influence upon the offspring of 
consanguineous marriages stated in its report that, 
if the family be free from degenerative taint, 
marriage among its members in no way dimin- 
ishes the chances of healthy offspring. Other 
authorities also agree that there is no greater 
amount of disease or deformity among the off- 
spring of parents related to each other by blood 
than among the children of parents not so related, 
provided the parents be equally free from ten- 
dency to disease or degeneration. 

Such marriages, however, are almost certain to 
transmit in an accentuated form any disease or 
defect already present in the family. Inasmuch 
as at the present time almost every family has 
a taint or tendency to disease of some kind, 
and as all such imperfections are transmitted 
and rapidly deepened in the family by the inter- 
marriage of its members, it is best that such 
unions in all cases be forbidden. They should be 
discounten?nced even in healthy families, for such 
union may wake up some pathological character 
which has been latent for one or two generations. 



CHAPTER XII. 



REPRODUCTION THROUGHOUT NATURE. 

An Explanation of Nature's Mysteries. Reproduction: In 
Plants, in the Lower Animals, in Man. Conception. 
The Development and Nourishment of the Embryo or 
Unborn Child. The Placenta and Umbilical Cord. 
Changes in the Mother During Pregnancy. 

The physiology of so important an event as 
pregnancy should be understood by every woman. 
Emphasis has already been laid on the necessity 
of a mother's explaining Nature's mysteries to 
her daughter in an intelligent and tactful manner. 
Matters of this kind, however, should be regarded 
in a broad light, the whole world being included 
in the view. The description given on the fol- 
lowing pages, it is hoped, will not only make the 
matter clear to the mother, but will also suggest 
to her a way to present this delicate subject to 
her daughter. 

Everything Composed of Cells. 

When seen under the microscope, all plants and 
all animals are found to be composed of minute 
(94) 



REPRODUCTION THROUGHOUT NATURE 95 

bodies, called cells. The shape and kind of these 
cells vary in different structures. The roots of 
a tree are made of one kind of cell, the leaves of 
another, the bark of a third, the fruit of still a 
fourth, and so on. In the same way skin, muscle, 
bone, hair and nails are each composed of a dif- 
ferent kind of cell. 

All new individuals begin with one cell, which 
divides and subdivides until it forms many cells, 
each of which grows and divides again. The 
ovule in a seed divides, some of its cells forming 
roots, others becoming stem and leaves. 

Various Methods of Reproduction. 

The original cell that forms the new body is 
produced in various ways. In the yeast plant and 
in the hydra the new cells appear as buds on the 
parent cell. Sometimes, as in seaweed and in the 
green slime or algae seen on stagnant pools, the 
parent cells divide into two daughter cells. In all 
higher forms of life, however, a union of two 
dissimilar cells is necessary to form the first cell 
of the young organism. Most plants and animals 
develop certain cells, whose sole object is to per- 
petuate the species. These reproductive cells 
usually are of two kinds. One kind, called the 
female, becomes converted into the young cell as 



96 REPRODUCTION THROUGHOUT NATURE 

soon as it comes in contact with the other kind, 
called the male. 

In flowers the pistil is the female element, its 
stigma and style forming a tube leading down to 
the ovary, in which lies the ovule or female repro- 
ductive cell. The pollen on the stamens represents 
the male reproductive cell. When blown by the 
wind down the style of the pistil, or carried down 
on the antennae or sucking tubes of insects, the 
pollen fertilizes the ovule which lies at the bottom. 
As soon as the ovule comes in contact with the 
pollen it begins to divide and finally becomes a 
seed, capable of producing another plant. 

In animals, as a rule, a union of the male and 
female elements is necessary. As the impregnated 
cell divides, a living creature begins to be formed, 
which at first is not always like the parent. From 
the egg laid by the butterfly crawls the caterpillar, 
which later builds its cocoon, whence it emerges 
a fully developed butterfly. The tadpole is 
hatched from the egg of a frog and, after con- 
tinuing to grow as a water animal, it one day 
sheds its skin and becomes a frog. 

Reproduction in Human Beings. 

Every month a woman discharges from the 
ovary a mature ovum, which enters the funnel- 



REPRODUCTION THROUGHOUT NATURE 97 

shaped end of the Fallopian tube and travels 
down toward the uterus. If at this time any 
male cells, called spermatozoa, happen to be in 
the tube, having worked their way up through the 
uterus from the vagina, one of them may pene- 
trate the ovum, or female reproductive cell. 

The moment the two cells unite, conception has 
occurred ; the resultant cell formed by this union 
is the beginning of the future child. This cell 
divides into two cells and then into four, eight, 
sixteen, and so on. 

As the cell or egg divides, it passes into the 
cavity of the uterus, where it lodges in one of the 
folds of the thickened lining membrane. Here 
for nine months it develops, first into an embryo 
with gills and a tail, then into a fetus, or crudely 
formed child, and finally into a normal infant. 
The shell or outer part of the egg is formed by 
the membranes. The developing child lies sur- 
rounded by the waters, or amniotic fluid. As the 
cells continue to divide, they become specialized, 
some going to form the skin, others to make 
muscles, bone, and so forth. 

Nourishment of the Child Within the Womb. 

The fetus is nourished by the mother's blood, 
which enters its body at the umbilicus, or navel. 

7 



98 REPRODUCTION THROUGHO UT NATURE 

Three long blood-vessels extend from a thickened 
spot on the uterine wall, called the placenta 
(which forms part of the after-birth), to the 
child's navel, at which point they enter the body. 
These vessels are surrounded. by a jelly-like sub- 
stance, which protects them from injury and with 
which they form the umbilical cord. 

Shortly after the child is born the umbilical 
cord is tied off and severed, the infant's end then 
drying up and later falling off. 



CHAPTER XIII. 



THE SIGNS OF PREGNANCY. 

Determination of the Existence of Pregnancy. The Com- 
monest Symptoms of Pregnancy: The Cessation of 
Menstruation; Morning Sickness; Appearance of the 
Face; Changes in the Breasts; Changes in the Size, 
Shape and Appearance of the Abdomen. Quickening. 
Alterations in the Nervous System. Change in Color 
of the Mucous Membrane. Hearing the Fetal Heart 
Sounds. The Physician's Examination. 

Determination of the Existence of Pregnancy. 

As a rule, it is not a difficult matter to deter- 
mine whether a woman is pregnant, although 
cases have occurred in which mistakes were made. 
Physicians have operated on a supposed abdom- 
inal tumor only to find a pregnant uterus. 

There are certain symptoms, however, which 
are usually present in a woman with child. But 
they may occur in conditions other than preg- 
nancy, and they may be absent, though the woman 
be "in a family way." The physician is the only 
person who is competent to decide. 
(99) 



100 THE SIGNS OF PREGNANCY 

The most common symptoms of pregnancy 
experienced by the mother are (i) cessation of 
menstruation, (2) "morning sickness," (3) 
changes in the size, shape and appearance of the 
abdomen, (4) changes in the breasts, and (5) 
quickening. 

The Cessation of Menstruation. 

As soon as a woman becomes pregnant, men- 
struation usually ceases. But absence of the 
menstrual flow may depend upon other causes, 
as in the condition known as amenorrhea, de- 
scribed in Chapter VII on "Disorders of Men- 
struation." In some few cases there is a slight 
bloody discharge during the first three months of 
pregnancy. It will thus be seen that the sign is 
not an invariable one. 

"Morning Sickness." 

At the sixth or seventh week of pregnancy 
nausea and vomiting appear, usually lasting to 
the third month, being worse when the woman 
first arises from bed .in the morning, whence it 
derives the name "morning sickness." It is not 
always present and may exist in many other 
conditions. 



THE SIGNS OF PREGNANCY 101 

The Appearance of the Face. 

After conception has occurred, dark, irregular 
splotches, resembling freckles, called chloasmata 
or liver marks, may appear in the brow and 
cheeks, sometimes running so closely together as 
to form the so-called "mask of pregnancy." Dark 
rings often form under the eyes. These, too, 
occur in other conditions and cannot be regarded 
as diagnostic. 

Changes in the Breasts. 

During pregnancy the breasts become enlarged 
and distended and the veins can be plainly seen. 
As the distension continues, white lines or striae, 
resembling cracks, appear in the skin. 

The nipples themselves also stand out more 
prominently. The colored areola surrounding 
them grows darker in color and broader in extent. 
Little glands in this areola often are enlarged to 
the size of buckshot and project conspicuously. 
As pregnancy advances, a drop or two of a 
cloudy liquid, called colostrum, can be squeezed 
or milked out of the breast. The woman usually 
experiences a tingling sensation in the breasts, 
owing to their congestion, and later a feeling of 
fullness when the colostrum begins to appear. 

All of these changes may occur without the 



102 THE SIGNS OF PREGNANCY 

existence of pregnancy ; some, and rarely all, may 
be absent, even though that condition be present. 

Changes in the Abdomen* 

There is a progressive enlargement of the 
abdomen as the womb increases in size. Enlarge- 
ment of the abdomen, however, occurs in many 
other conditions, and, on the other hand, it has 
existed without attracting the woman's notice. 

After the eighth month a change takes place 
in the shape of the abdomen as the child's head 
sinks into the pelvis and its body falls a little 
forward. This phenomenon is known as "light- 
ening" or "dropping." With it there is a lowering 
of the waist line; the upper part of abdomen 
becomes flatter and the navel more prominent. 

The umbilicus or navel becomes gradually 
pushed out or everted. At the sixth month it is 
on a level with the surface of the abdomen, and 
later begins to pout. It is surrounded by a* black 
ring, from which a black line extends along the 
middle of the abdomen upward to near the pit of 
the stomach and downward to the pelvis. This 
line is given the name of linea nigra, which means 
black line. 

Owing to the stretching of the abdomen, white 
lines or striae, looking like cracks, appear in the 



THE SIGNS OF PREGNANCY 103 

skin, especially in the region of the flanks and the 
hips and along the outer side of the thighs. 

The Occurrence of Quickening. 

A living fetus, or unborn child, moves about 
within the womb, but not until about midway 
between the fourth and fifth months are the 
movements powerful enough to be felt by the 
mother. The sensation the mother experiences 
when the fetus moves is called "quickening/' It 
has been felt as early as the third month, but may 
not be noticed at all until the last month. During 
the advanced stages of pregnancy fetal move- 
ments can usually be felt by a person laying a 
cold hand suddenly upon the woman's abdomen. 
There are two kinds of sensations conveyed to 
the hand ; a heaving and a sensation compared to 
that of a finger tap under a blanket. 

Necessarily, movements are never felt when the 
fetus is dead. They may be undetected even when 
it is living. There are many things, moreover, 
which may simulate these movements and thus 
lead one astray. 

Alterations in the Nervous System. 

A pregnant woman usually exhibits some dis- 
order of the nervous system, becoming more sen- 






104 THE SIGNS OF PREGNANCY 

sitive and irritable. Her disposition may change 
from placidity to vivacity, or from amiability to 
sullenness or moroseness. Sometimes the moral 
nature is affected, with impairment of the ability 
to distinguish between right and wrong. The 
appetite may become very fanciful and the most 
unusual articles of diet may be craved. Often a 
woman experiences a sense of dizziness or a feel- 
ing as if she were going to faint, or she may even 
lose consciousness. Neuralgia, especially of the 
face and teeth, is not uncommon. 

Such symptoms, of course, cannot solely be 
regarded as indicative of pregnancy. 

Change in Color of the Mucous Membrane. 

During the second half of the period of gesta- 
tion, and sometimes as early as the second month, 
the mucous membrane of the vagina assumes a 
bluish or purplish hue, which has been compared 
to the color of the lees of wine. About the same 
time the color of the mucous membrane about 
the entrance changes from a pink to a bright 
scarlet. 

These are not infallible signs, however, as they 
may be produced by other conditions and may 
even be absent throughout the whole of preg- 
nancy. 



THE SIGNS OF PREGNANCY 105 

Hearing the Fetal Heart Sounds. 

After the fifth month, if the fetus is alive, its 
heart sounds can usually be heard by applying 
the ear to the woman's abdomen. The place 
where they commonly are heard best is a spot 
about an inch below the navel, to the left (some- 
times to the right) of the median line. The heart 
of the unborn child beats at the rate of 120 to 
160 a minute. Two sounds are heard with each 
beat. The sound has been compared to the tick- 
ing of a watch under the pillow. It must not be 
mistaken for the woman's heart beat, which keeps 
time with her pulse. Many conditions may 
prevent the fetal heart sounds being heard. 

The Physician's Examination. 

There are some signs of pregnancy that are 
found on an internal examination, which, of 
course, only the physician can make. It is impos- 
sible, however, for any one to make a positive 
diagnosis of pregnancy before the sixth week, 
and sometimes not until the fourth month. 



CHAPTER XIV. 



THE HYGIENE OF PREGNANCY. 

Diet. Dress. Bathing. Work, Exercise and Rest. 
Maternal Impressions. Care of the Breasts. Marital 
Relations During Pregnancy. Attention to Teeth. 
Avoidance of Constipation. Medical Supervision Dur- 
ing Pregnancy. 

Many women make no change in their lives 
with the advent of pregnancy, but continue as 
though their condition is attendant with no 
danger. Such a view is erroneous ; the border line 
between health and disease may easily be passed 
during pregnancy unless the woman is careful 
about her mode of life and reports to her physi- 
cian any unusual symptoms that may develop. 
The health of the child as well as that of the 
mother depends in great measure upon the 
hygiene of this period. 

Diet. 

During pregnancy a simple diet is best. Meat 
should be eaten but once a day and then only in 
(106) 



THE HYGIENE OF PREGNANCY 107 

small quantities, cereals, fresh vegetables and 
fruits forming the principal articles of food. It 
is well to take large quantities of milk — plain, 
diluted with plain or effervescing water or with 
lime-water or barley-water, cooked with vege- 
tables, or made into puddings, etc. The woman 
must be careful to avoid rich and indigestible 
foods. She should drink water freely, at least 
one or two quarts during the day. Alcoholic 
drinks are prohibited, tea and coffee being 
restricted to small amounts. 

Morning sickness may sometimes be prevented 
if before getting up, while lying flat on her back 
in bed, the woman takes a hot drink of milk, 
broth, cocoa, chocolate, tea or coffee, with or 
without toast, and remains in bed for half an 
hour afterwards, before attempting to get up. 

Dress. 

During pregnancy more than at any other time 
care about clothing is important. It is best to 
wear silk or wool next to the skin. Circular 
garters are decidedly objectionable. All com- 
pression about the waist must be avoided. It is 
necessary, therefore, to discard the ordinary 
corset and to wear in its place an hygienic waist 
or corset made especially for pregnant women. 



108 THE HYGIENE OF PREGNANCY 

Heavy skirts and tight bands must also be 
avoided, skirts being suspended from the shoul- 
ders by means of suspenders or a waist. 

When the abdominal walls are weak, the 
muscles become so overstretched that after labor 
they may fail to properly hold up the various 
organs, with resultant protuberant abdomen, 
filling of the stomach and intestines with gas, 
movability of the kidneys and dropping of the 
stomach and other viscera. These consequences 
may be prevented and the abdominal muscles 
strengthened by practicing certain exercises before 
pregnancy, and by participation in various sports. 
The maternity waists and corsets will furnish 
some support to the abdomen. Great relief may 
be afforded by wearing a broad, properly adjusted 
abdominal bandage made of flannel, muslin or 
ribbed wool, or of silk and elastic. 

High-heeled shoes are very injurious, as they 
throw forward the trunk, which already tends to 
fall in that direction, and cause the woman to 
bend back her head and shoulders to keep her 
balance, thus straining the muscles along the 
spine. 

Bathing. 

It is especially important during pregnancy to 
promote excretion by the skin by means of fre- 



THE HYGIENE OF PREGNANCY 109 

quent warm tub baths with an abundant use of 
soap, taken best at night just before retiring. 
For its general hygienic effect a cool sponge bath 
in the morning is beneficial. Very hot and very 
cold baths, foot-baths and surf-bathing are dan- 
gerous during pregnancy. 

Work, Exercise and Rest. 

A pregnant woman would do well to reduce her 
work to below what she is accustomed to, never 
allowing herself to become fatigued and particu- 
larly avoiding jarring and straining. It is best 
not to work on the sewing-machine, move heavy 
furniture, lift a heavy weight, reach to a shelf, or 
do violent sweeping. 

Advantage is derived from moderate daily 
exercise, such as walking in the open air and 
sunlight, or being driven in an easy carriage over 
smooth roads, but without handling the reins. 
General massage is beneficial, but must not include 
the abdomen. Horseback-riding, however, bi- 
cycling, golf, tennis, dancing, swimming, and all 
similar forms of violent exercise, are to be 
avoided. While in this delicate condition the 
woman should not take a sea- voyage, nor should 
she travel much. 

The pregnant woman requires plenty of sleep. 






110 THE HYGIENE OF PREGNANCY 

It is well to undress after the midday meal and 
lie down for an hour or so. 

Maternal Impressions. 

In every bushel of chaff there can usually be 
found a grain or two of wheat. Similarly, despite 
the doubts cast by many physicians, there is an 
element of truth in the popular belief that strong 
impressions made on the mother during pregnancy 
leave their imprint on the child. Sudden emotions 
of grief, fear and anger often do have an influence 
on the developing fetus. 

It is therefore important to protect the preg- 
nant woman from disagreeable or heartrending 
sights and associations, bad news, fright, and the 
like. She should lead a placid, quiet life, amid 
cheerful surroundings, having pleasant diver- 
sions, such as entertaining books, beautiful pic- 
tures, and good music. Only harm results from 
worrying over her approaching confinement or 
studying about the various complications that 
occasionally are met with. Nor is any good 
accomplished by listening to the harrowing tales 
of gossiping neighbors or of a thoughtless nurse. 
The mind can rest at ease with the knowledge 
that labor as a rule is a perfectly natural and 
normal process through which hundreds of 



THE HYGIENE OF PREGNANCY 111 

women pass successfully every day, and that com- 
plications and accidents are of very rare occur- 
rence. A woman may also derive comfort from 
the thought that if she live hygienically she will 
be more likely to have an easy and uncomplicated 
labor, followed by a normal convalescence. 

If the woman becomes melancholy or shows 
any signs, however slight, of a deranged mind, 
the physician must be informed of the fact. 

More than at any other period of her life, the 
wife during pregnancy requires the most thought- 
ful consideration of her husband. 

Care of the Breasts. 

It is advisable not to allow the clothing to 
press upon the breasts. If the latter cause distress 
on account of their increasing size and weight 
they may be supported according to one of the 
methods described in Chapter XX on the man- 
agement of the woman after labor. They should 
be washed daily with soap and warm water, any 
scales upon the nipples being removed. 

When the nipples are flat or retracted they 
must be drawn out during the latter months of 
pregnancy, so that they will develop into a shape 
that the baby can grasp. This may be done by 
gently pulling them out from the breast with the 



112 THE HYGIENE OF PREGNANCY 

thumb and index finger every night and morning, 
or by the use of the breast pump, or by covering 
them with a nipple protector or a nipple shield. 

The nipples will be rendered less sensitive and 
less liable to fissures if, during the last month of 
pregnancy, they are washed every morning with 
cold water and then anointed with a mixture con- 
taining equal parts of water and glycerite of 
tannic acid, applied on a piece of absorbent cotton. 

Marital Relations During Pregnancy, 

The marital relations need not necessarily be 
suspended throughout pregnancy, except during 
the early and late months, when the liability to 
abortion is greatest. Moderation, however, must 
always be strictly observed. Sometimes conti- 
nence is recommended, and is imperative if the 
woman have a tendency to abort. During the 
days corresponding to the usual menstrual period 
intercourse is always to be avoided. 

Attention to Teeth. 

On account of the tendency during pregnancy 
to decay of the teeth, it is well to have the teeth 
examined during the early months of pregnancy 
and whenever they give pain. At such times the 
dentist must be informed of the woman's condi- 



THE HYGIENE OF PREGNANCY 113 

tion so that in his treatment he may be guided 
accordingly. 

Avoidance of Constipation. 

Constipation sometimes becomes aggravated 
during pregnancy. In many instances it occurs 
only at such times. Adherence to the hygienic 
hints given in this chapter will help in avoiding 
it. Great assistance may also be had from the 
directions given for the relief of constipation in 
Chapter XXII. 

Medical Supervision During Pregnancy. 

While pregnancy ordinarily is a normal proc- 
ess, complications in many cases do occur. These 
can usually be prevented by careful management. 
Whenever, therefore, a woman believes herself 
pregnant, she should consult her physician and 
report from time to time as he may direct, sending 
a specimen of her urine at least once a month. In 
this way not only will she be more likely to pre- 
serve health and comfort during pregnancy, but 
there will be less danger of complications at the 
time of her confinement. 

Should her health suffer, especially if symp- 
toms develop such as swelling of the legs or face, 
dimness of vision, the occurrence of black specks 

8 



114 THE HYGIENE OF PREGNANCY 

or flashes of light before the eyes, faintness, 
bleeding from the vagina, or acute abdominal 
pain followed by faintness, a woman must inform 
her physician. Even should the condition prove 
to be unimportant, no harm has been done; while 
failure to report may lead to serious results, even 
to death. Other phenomena that should be made 
known to the physician are rapid increase in the 
size of the abdomen, very active and violent move- 
ments of the child, cessation of all motion, and a 
noticeable projection in any part of the abdomen, 
with unusual movements of the child, 



CHAPTER XV. 



STERILITY. 



Causes of Sterility in Women. Prevention. Cure. 
Race Suicide. 

By sterility is meant the inability to produce 
offspring. It is believed that about one out of 
every eight or ten marriages is barren. The fault, 
however, does not always lie with the woman ; in 
every six childless marriages about one is due to 
sterility in the husband. Consequently in every 
case of barrenness, before the wife is subjected to 
examination or treatment, the husband should 
first consult a physician. 

Causes of Sterility in Women. 

Sterility in the female may be due to one of 
many causes. It may result from some abnor- 
mality or malformation of the internal or external 
generative organs, a condition that may have 
existed since birth. The presence of a tumor may 
prevent conception. A displacement or bending 
(115) 



116 STERILITY 



of the womb may have a similar effect. Lacera- 
tions or tears that have occurred during labor and 
have not been repaired likewise may interfere 
with the child-bearing function. One of the com- 
monest causes of sterility is inflammation of the 
womb, especially when this has become chronic. 
Disease of the ovaries also frequently produces 
such a condition. Disease of the Fallopian tubes, 
however, is the most common cause. As the 
ovum must pass through the tube in order to 
reach the womb, anything that tends to prevent its 
passage by blocking or constricting the tube will 
prevent its fertilization. The tubes become 
blocked and constricted as the result of inflam- 
matory processes, both acute and chronic. Acute 
inflammation of the Fallopian tubes is usually due 
to septic infection, occurring at child-birth or 
during a miscarriage. Chronic inflammation, a 
much more common condition, has its origin 
usually in gonorrhea, and occurs not rarely in 
young married women who have been infected by 
their husbands. Sterility also sometimes results 
when the vaginal discharge or leucorrhea that 
accompanies inflammation of the uterus or of the 
vagina is of such a character as to destroy the 
spermatozoa or male cells. 

There are several general conditions that may 



STERILITY 117 



be responsible for sterility. The one of most 
frequent occurrence is great obesity. Very fat 
women are usually barren. Some authors seem 
to think that the body cannot both produce fat 
and produce offspring. It is well known that at 
the age when child-bearing ceases women often 
become stout, and that women who soon after 
marriage rapidly accumulate fat rarely have more 
than one or two children. A woman who suffers 
from anemia may be sterile in consequence. Dis- 
eases such as diabetes, cancer, consumption and 
Bright's disease may also be associated with 
barrenness. 

The habitual use of alcohol is apt to prevent 
the occurrence of conception. Women addicted 
to self-abuse also seldom bear children. Authori- 
ties have come to the conclusion that in some 
cases sterility is due to a lack of affinity, so to 
speak, between husband and wife. Lack of mod- 
eration in the marital relations may lead to a 
similar result. 

In each case the physician must decide what is 
the cause. 

Prevention. 

Knowing the causes that produce sterility, one 
can often prevent such an occurrence by avoiding 



118 STERILITY 

them. Any diseased condition should be attended 
to at once. It is important that lacerations be 
repaired as soon as possible after they occur. A 
displaced organ must be put back in position. 
Proper care during and after a labor or miscar- 
riage will do much toward preventing barrenness. 
In addition to the moral aspect, the fact that a 
woman who has an abortion performed on her 
usually becomes sterile should act as a deterring 
factor to those who regard with complacency this 
destruction of a human life. If women would 
insist on marrying only those men whose lives 
have been pure, many more marriages would be 
fertile than are so at the present day. 

Cure. 

Before the proper remedy can be applied, the 
cause of the unproductiveness in the individual 
case must be recognized. In every instance the 
investigation should include both the husband and 
the wife. Consequently, before a woman is sub- 
jected to an examination it would be well for the 
husband to consult a reliable physician, who will 
determine whether or not the fault lies with him. 
If this investigation proves negative, the wife 
should put herself in the hands of a competent 
physician. Neither man nor woman ought ever 



STERILITY 119 



have anything to do with physicians who adver- 
tise — the so-called "quacks." 

Some cases of barrenness can be cured, others 
cannot. Those due to errors in development and 
to malformations are rarely, if ever, amenable to 
treatment. When sterility is caused by abnormal 
conditions resulting from chronic inflammation 
of one or more of the organs of generation, or to 
a malposition, or to a laceration, the surgeon or 
gynecologist is often able to effect a cure. With 
the reposition of the displaced organs, with the 
repair of the lacerated structures, with the re- 
moval of the inflamed tissues, or with the treat- 
ment of the leucorrheal discharge, conception may 
occur. 

Sterility due to the presence of a general dis- 
ease often disappears with the cure of the disease. 
When it is the result of unhealthy modes of life, 
the woman herself can do much toward relieving 
the condition. Often a change of air and scenery 
is of benefit. For very fat women sufficient exer- 
cise and an appropriate diet will usually be pre- 
scribed by the attending physician in accordance 
with their individual requirements. The cure is 
not far to seek in women addicted to the use of 
alcohol. Matthews Duncan has described the case 
of -an intemperate woman who was sterile for 



120 STERILITY 



many years, but who became pregnant on abstain- 
ing from drink. Moderation should be observed 
in the marital relations and all bad habits avoided. 
The observance of the above precautions may 
be rewarded by the blessing of offspring in a 
hitherto childless marriage. 

Race Suicide. 

There are many, especially among the well-to- 
do, in whom there is a relative sterility brought 
about by voluntary sexual abstinence or by prac- 
tices which prevent conception. The cause in 
such cases is usually what has been termed "the 
gospel of comfort." 

Theodore Roosevelt, in an address before the 
National Congress of Mothers, thus expressed his 
opinion concerning the question: 

"There are many good people who are denied 
the supreme blessing of children, and for these 
we have the respect and sympathy always due to 
those who, from no fault of their own, are denied 
any of the other great blessings of life. But the 
man or woman who deliberately foregoes these 
blessings, whether from viciousness, coldness, 
shallow-heartedness, self-indulgence or mere fail- 
ure to appreciate aright the difference between the 
all-important and the unimportant — why, such a 






STERILITY 121 



creature merits contempt as hearty as any visited 
upon the soldier who runs away in battle, or upon 
the man who refuses to work for the support of 
those dependent upon him, and who, though able- 
bodied, is yet content to eat in idleness the bread 
which others provide. 

"The existence of women of this type forms 
one of the most unpleasant and unwholesome 
features of modern life." 



CHAPTER XVI. 



MISCARRIAGE AND ITS PREVENTION. 

Causes. The Signs of a Miscarriage. The Danger of an 
Abortion or Miscarriage. Prevention. To Avert a 
Threatened Miscarriage. Treatment of an Inevitable 
Miscarriage. The After Treatment of a Miscarriage. 

The fetus is sometimes expelled before it has 
reached its full development. Such an accident 
may occur at any time during the course of 
pregnancy. 

The course of an abortion or miscarriage is 
much the same as that of a labor at term. The 
contraction of the uterus in its efforts to expel 
its contents causes a gradual dilatation of the os 
or mouth of the cervix, which is followed by the 
expulsion of the embryo and its membranes, 
together with the placenta or afterbirth. After 
this, the womb contracts still further until it has 
again reached is normal size. 

Causes* 
There are many conditions that produce a mis- 
carriage. When the fetus is diseased it may be 

(122) 



MISCARRIAGE AND ITS PREVENTION 123 

expelled prematurely. The presence of syphilis 
in either of the parents often leads to a similar 
termination of pregnancy. The woman, more- 
over, is suspectible to a number of influences 
which sometimes cause a miscarriage ; a blow or 
a fall even producing it. Occasionally the uterus 
is extremely irritable, so much so that it is excited 
to contraction by the most trivial occurrence, such 
as washing at the tub, sweeping, dancing, taking 
a long walk, a horseback ride or a surf bath, 
making a misstep, being jolted by a carriage, 
being subjected to a fright or shock, and so forth. 
Anything that shakes or agitates the womb may 
have a similar effect. Consequently when the 
woman suffers from St. Vitus' dance, uncon- 
trollable vomiting or coughing, or from convul- 
sions due to kidney trouble or epilepsy, hysteria 
or other nervous affections, her pregnancy is 
liable to be interrupted. She may also lose the 
child when she is attacked with a severe general 
disease such as pneumonia. Inability of the 
uterus to expand on account of a backward dis- 
placement or because it is over-distended with 
twins or with an excess of the waters or liquor 
amnii usually produces a miscarriage. Excessive 
cohabitation during pregnancy is also a frequent 
cause. 



124 MISC ARRIAGE AND ITS PREVENTION 

The Signs of a Miscarriage. 

A condition always present when a miscarriage 
is threatened, or has actually occurred, is hemor- 
rhage. The bleeding may be slight or excessive. 
The blood usually does not flow in a steady 
stream, but is expelled from time to time in the 
form of clots. Yet, as there are other conditions 
which might cause a hemorrhage, this symptom 
alone cannot be regarded as diagnostic. 

Pain is an almost constant symptom, its inten- 
sity being greater the further the pregnancy is 
advanced. It may, however, be absent, especially 
in early miscarriages. 

The one sign by which the occurrence of a 
miscarriage can be verified or, to use a medical 
term, diagnosed, is the expulsion of all or part of 
the ovum. The appearance of the substance 
expelled varies, depending upon whether or not 
the embryo is surrounded by its various cover- 
ings. When enveloped in the membranes it may 
appear as a ball of flesh, which, on being opened, 
is found to contain the embryo. Again, it may 
be cast ofT as a sack with thin transparent walls, 
through which the embryo may be seen lying in 
the waters. Sometimes the whole ovum is so 
minute that it escapes among the clots of blood 
without being noticed. If the portions of m#m- 



MISCARRIAGE AND ITS PREVENTION 125 

branes, which resemble pieces of flesh, are floated 
in water they are seen to be studded over with 
little projections which give to them somewhat 
the appearance of a chestnut burr. 

When the whole embryo is expelled with all 
its membranes, the miscarriage is said to be com- 
plete. An incomplete abortion or miscarriage, on 
the other hand, occurs when a portion of the 
embryo or of its membranes remains behind 
within the uterus. 

The Danger of an Abortion or Miscarriage. 

Every abortion or miscarriage is attended with 
a certain amount of danger. When the ovum is 
not expelled in its entirety, the portions of mem- 
branes remaining behind in the womb may 
putrefy, and poison the whole system, or else by 
their presence prevent firm contraction of the 
womb, thus causing a persistent hemorrhage. The 
mortality of miscarriage is almost as high as 
that of child-birth. Most fatal of all are the 
criminal and self-adduced abortions. In these 
cases there is also the danger of blood poisoning 
or infection from hands or instruments that w r ere 
not surgically clean. The added risk of injury 
from the unskilful use of instruments is also very 
great. 



126 MISCARRIAGE AND ITS PREVENTION 

Prevention. 

When it is known that, owing to an irritable 
uterus, a woman has a tendency to abort, every 
precaution should be taken to guard her from 
any influence that might stimulate the contraction 
of the uterus. At the times corresponding to her 
menstrual periods all efforts in this direction must 
be redoubled. It is important to protect the 
woman from nervous shocks, undue physical 
exertion, errors in diet and marital intercourse. 
In the most severe cases rest in bed may be neces- 
sary, sometimes for the whole or greater part of 
pregnancy, certainly during those days upon 
which the menstrual period usually falls. 

When the cause of the habitual miscarriage is 
known, treatment is naturally directed to its 
removal. A displaced uterus is restored to its 
proper position and kept there. A general disease 
such as syphilis always requires treatment. 
Coughing, vomiting and convulsions should 
receive appropriate management. In each case the 
physician in charge will decide what is to be done. 

To Avert a Threatened Miscarriage, 

When, during the course of a normal preg- 
nancy, bleeding from the vagina is observed, a 
miscarriage is threatened, The woman in whom 



MISCARRIAGE AND ITS PREVENTION 127 

this occurs often is perfectly healthy and of sound 
constitution, with normal generative organs, and 
who never previously has aborted. Some extra 
exertion or some slight violence, however, may 
have partially separated the developing fetus from 
the wall of the womb. If no suspicious flesh-like 
pieces have been passed, there is often a chance of 
averting this accident. 

The woman must at once be put to bed on her 
back in a darkened room where everything is 
kept quiet. The external genital region is 
cleansed thoroughly with soap and water and 
then bathed with a I to iooo bichlorid of mercury 
solution. A sterile gauze dressing should next be 
applied and held in place by a T-bandage, which 
consists of two strips of muslin about four to six 
inches wide, fastened together to form a T. The 
top or bar of the T is tied about the waist and the 
stem or tail of the T is brought down in the back- 
and carried over the gauze dressing to the front, 
whence it is brought up again, the end being 
fastened to the part that goes around the waist. 
The physician, who should be immediately sum- 
moned, will probably give medicines that will 
diminish the nervous sensibility and render the 
uterine muscles less irritable. 

It cannot be emphasized too strongly that in 



128 MISCARRIAGE AND ITS PREVENTION 

every case where bleeding from the womb occurs 
during pregnancy the physician must be sent for 
at once and that everything passed must be saved 
for his inspection. 

Treatment of an Inevitable Miscarriage. 

When a miscarriage cannot be prevented, it is 
treated in much the same manner as a labor at 
term. A physician should always be called in. 
Strict asepsis must be observed as described later 
in Chapter XIX. Everything that comes in con- 
tact with the woman — hands, instruments and 
dressings — must be surgically clean. All clots 
and all dressings must be saved for examination 
by the physician; in this way he will be able to 
tell whether or not the whole embryo w T ith all its 
coverings has been passed — a most important 
point. The precise line of treatment to be fol- 
lowed in each case will always be directed by the 
physician in charge. 

The After Treatment of a Miscarriage. 

A great deal of unnecessary sickness and 
chronic invalidism is due to the fact that women 
do not thoroughly appreciate the necessity of 
recovering completely from a miscarriage before 
taking up their daily work. Too often do they 



MISCARRIAGE AND ITS PREVEN TION 129 

regard a miscarriage as a matter of little moment 
and insist on being up and about in a few days 
after this accident. It is often with the greatest 
difficulty that a physician can persuade his patient 
to remain in bed for ten days. 

The after treatment of a miscarriage is as im- 
portant as that of a delivery at full term. The 
author does not w T ish to unnecessarily alarm a 
woman who may have met with a miscarriage by 
enumerating the many sources of danger con- 
nected with neglect of this condition. He 
therefore will merely state that if a woman desires 
to undergo a complete recovery after having a 
miscarriage, she must obey implicitly all the in- 
structions of her physician. If she follows his 
advice faithfully she will probably never in the 
future experience any ill effects of her mishap^ 



CHAPTER XVII. 



PREPARATIONS FOR THE CONFINEMENT. 

The Lying-in Room. Arrangement of the Bed. Things 
Needed for the Confinement. The Baby's Basket. 
The Baby's Clothes. Preparation of the Patient. 
Engaging the Accoucheur. Physician vs. Midwife. 
The Selection of a Nurse. The Nurse's Duties. 

In preparing for the confinement, it is impor- 
tant to know what is best to do and, if possible, 
to put that knowledge into practice. Unfortu- 
nately, however, a woman is not always able to 
do as she wishes. The best is oftentimes unattain- 
able, in which case the best under the circum- 
stances must suffice. Whenever possible the 
directions given in this chapter should be implic- 
itly followed; they are simple and necessary. 
Nevertheless, for persons who for any reason are 
unable to adopt the first and best suggestions 
made, other less expensive and in some cases 
improvised methods are also given, which, though 
less desirable, are serviceable and good, and 
possible and practicable for everyone. 
(130) 



PREPARATIONS FOR CONFINEMENT 131 

The Lying-in Room. 

The room usually selected for the confinement 
is the prospective mother's own bedroom. It 
ought to be large and sunny, well lighted, welE 
ventilated and properly heated. A communicating 
room for the nurse is a great convenience, leaving 
the mother the exclusive use of her own. Matters 
are also made easier if the bathroom be near. All 
unnecessary furniture, heavy curtains, and all 
bric-a-brac should be removed. If a carpet is on 
the floor it may be taken up, or the portion about 
the bed may be protected by a large rubber 
mackintosh, or oilcloth, or by several layers of 
newspaper. Rugs are removed. It is well to 
take out of the room anything that might collect 
dust, which often is a carrier of disease germs. 

The Arrangement of the Bed.' 

A narrow and high bed is preferable, placed 
where it will be out of draughts. As it must be 
accessible from both sides, it is not placed against 
the wall. The mattress should be firm, hair being 
the best material. To prevent its sagging in the 
middle, three table boards, or shelves from a 
book-case, may be placed in the middle of the bed 
between the mattress and the spring. 

When the bed is arranged for the labor, draw- 



132 PREPARATIONS FOR CONFINEMENT 

sheets of rubber and cotton are sometimes placed 
across the middle of the bed over the under sheet. 
This is known as the "permanent bed,'' but, 
though convenient and elegant, is often dis- 
pensed with. Over the "permanent bed/' when it 
is used, otherwise over the mattress, are placed a 
second rubber draw-sheet and a second cotton 
draw-sheet, sometimes folded once. These con- 
stitute the "temporary bed/'' which is removed 
immediately after delivery. 

If the bedstead is double, instead of single, the 
temporary bed is arranged at the side where the 
patient is to lie, being securely fastened with large 
safety pins. Instead of the rubber sheet, a piece 
of mackintosh may be substituted, or a piece of 
oilcloth that has been thoroughly scoured. When 
these are not to be had, use may be made of an 
old clean comfortable or of clean wrapping paper 
or even of clean newspapers. 

On the spot where the hips will lie is pinned an 
absorbent pad, which, as soon as soiled, should 
be taken off and burned, to be replaced by a clean 
one. Consequently several must be provided. 
They are best made of nursery cloth, consisting 
of two layers of muslin, each one yard square, 
with a layer of absorbent cotton, wood wool, jute, 
bran, or sawdust, two to four inches thick, loosely 



PREPARATIONS FOR CONFINEMENT 133 

quilted between them. They can be made at 
home or bought in the shops. They must be 
baked in the oven, or boiled for half an hour in a 
clothes boiler and thoroughly dried, then pinned 
up in a sheet and put away out of the dust. If 
towels or napkins or old pieces of muslin are used, 
they must be prepared in the same manner. 

It is well to have two sets of coverings, one for 
use during labor, and one to put on after the 
delivery. 

Things Needed for the Confinement. 

The occlusive bandages or napkins are best 
made of carbolized gauze and salicylated cotton, 
which, however, are rather expensive. A cheaper 
dressing is made out of rolled absorbent cotton, 
or wood wool, and washed cheese cloth. Two 
thicknesses of the cotton, seven or eight inches 
long and four or five inches wide, are enclosed in 
a quarter yard of the gauze or cheese cloth and so 
folded as to make a pad (sixteen or eighteen 
inches long and four or five inches wide), the 
edges being stitched. 

Sometimes old pieces of muslin or other mate- 
rial, which have been boiled, are used. Three or 
four dozen will be required. The hands that 
make them must be scrupulously clean. When 
made beforehand they should be put into a clean 



134 PREPARATIONS FOR CONFINEMENT 

pillow case, or wrapped in a sheet, and thus boiled, 
steamed or baked. They then should be kept 
covered and put away in a clean place, free from 
dust. 

The abdominal bandage or binder is made of 
washed, unbleached muslin, about a yard and a 
quarter long and about half a yard wide. Some- 
times it is made only long enough to go around 
the abdomen once, in which case it is furnished 
with buttons and buttonholes in front and laces at 
the sides. It should fit firmly to give support to 
the stretched muscles, care being taken not to 
have it fastened tighter above than below. 

There should also be in the lying-in room a 
table, a chair, two basins and a bucket. 

The woman should have the following articles 
on hand, ready for the confinement. The abso- 
lutely necessary things are given in italics; the 
full list can only be obtained by the well-to-do. 
Hand towels, ether (one-half pound), brandy 
(two ounces), vinegar (four ounces), tincture 
of green soap (four ounces) or a new cake 
of pure soap, antiseptic tablets of corrosive 
sublimate (one bottle), a large, coarse, new 
sponge; a skein of bobbin (sterilized), a foun- 
tain syringe, a bed-pan, a new soft rubber 
catheter, absorbent cotton, salicylated cotton 



PREPARATIONS FOR CONFINEMENT 135 

(a one-pound package), carbolized gauze (five 
yards), nursery cloth (eight yards), unbleached 
muslin (two yards), large safety pins, car- 
bo lated vaseline, -fluid extract of ergot (one 
ounce), a pair of scissors to cut the cord. 

As soon as the labor has begun, three pitchers 
should be filled with water that has been boiled 
for half an hour and clean towels should then be 
tied over their tops. This is the only water to be 
used about the patient, 

The Baby's Basket. 

The baby itself must not be forgotten. A 
basket for the baby's things may be purchased or 
made at home. A cheap arrangement is an ordi- 
nary wicker hamper or shallow basket attached 
to a camp stool, lined with muslin and trimmed 
with silk, lace and ribbon or other suitable mate- 
rial, with a pocket at each corner. The frill from 
the basket covers the place where it joins the 
camp stool. The basket should contain large and 
small safety pins, a bath thermometer, talcum 
powder, a fine, soft sponge, a soft hair brush, 
castile soap, cold cream, alcohol for rubbing, 
blunt scissors for the nails, six wash-cloths of 
Shaker flannel, six inches square, old linen for 
cleansing the mouth, and a bath blanket. 



136 PREPARATIONS FOR CONFINEMENT 

The Baby's Clothes. 

The following list of clothes will be required 
for the baby. In stating the number needed, two 
figures are given, the least number one can get 
along with and the number one ought to have. A 
mother may be able to economize still further by 
washing frequently and thus using the same 
garment again. Four to six flannel or knit 
bands or binders ; three to six dozen diapers ; four 
to six pairs of knitted woolen socks ; three to four 
woolen shirts; four flannel night-skirts; four 
flannel day-skirts; four to six white day-skirts; 
six to ten slips; six to ten dresses; material for 
four or five flannel bands ; a soft pillow, fourteen 
by eighteen inches ; soft pillow covers ; knit wrap- 
ping blankets; sacques, wrappers, bibs, caps, blan- 
kets, veils, and so forth. 

Other Conveniences for the Nursery. 

Several other articles will be needed for the 
baby. They are : 

A bath-tub and two flannel bath aprons. 

Six old, soft damask towels. Bathing towels 
made from diaper cloth will answer when the 
damask ones are unobtainable. They should be 
repeatedly scrubbed and boiled to be rendered 
soft. 



PREPARATIONS FOR CONFINEMENT 137 

A small-sized clothes bars or clothes horse. 
This will be used for airing the baby's clothes 
and holding its towels. 

A low chair without arms. This is for the 
nurse to sit on when washing the baby. 

A screen. It should have a firm, square frame, 
solidly covered with cretonne, burlap or denim, 
so that it will afford real protection from draughts 
or light. A bamboo screen with curtains hung on 
rods will not answer. 

Preparation of the Patient. 
When the time for confinement approaches, it 
is important for a woman to keep her bowels 
loose, by means of laxatives if necessary. As 
soon as she begins to experience the pains she is 
given a rectal enema of a pint of soapsuds and a 
teaspoonful of turpentine. She should take a 
warm general bath, washing the external genitals 
thoroughly with soap and warm water. A vagi- 
nal douche is not desirable in a woman not suf- 
fering from a contagious discharge, unless it has 
been ordered by the doctor. 

Engaging the Accoucheur.^ 
As soon as pregnancy is suspected, it is well to 
engage the physician, as he is to have general 



138 PREPARATIONS FOR CONFINEMENT 

supervision over the woman's life, her diet, cloth- 
ing, exercise, and so forth, during the whole 
period between conception and labor. 

Pregnancy, although usually a normal process, 
is subject to various complications, for whose 
recognition and treatment a physician is required. 
The kidneys, in particular, need constant watch- 
ing, as they frequently become affected during 
this period. A four-ounce specimen of mixed 
night and morning urine should be sent to the 
physician for examination every two weeks until 
the last month, when it should be sent every week. 
A statement of the exact amount of urine passed 
during the twenty-four hours should accompany 
the specimen. 

When such symptoms as scanty urination, 
severe headache, dizziness, or swelling of the feet 
or face occur, they should be reported to the 
physician at once. 

A midwife, in the opinion of the writer, is not 
desirable, except in those cases where it is impos- 
sible to secure the services of a physician or 
medical student. The midwife rarely understands 
the meaning of surgical cleanliness, which is the 
most important factor in preventing infection or 
blood-poisoning. She, moreover, is unable to 
meet the various complications as they arise, but 



PREPARATIONS FOR CONFINEMENT 139 



always must send out for a doctor, who often 
arrives too late. Promptness at such a time in 
recognizing and meeting a serious condition is all- 
important. 

The Selection of a Nurse. 

A woman must choose between a trained nurse 
and the so-called monthly nurse. 

A trained nurse or graduate nurse, one who 
has completed a course of training in a hospital, 
should be procured if she can be afforded. Such 
a person not only has the requisite knowledge as 
well as experience, but she has learned how to 
obey the orders of the physician. 

The monthly nurse, on the other hand, has not 
had careful hospital training, being merely a 
woman who makes a practice of nursing mater- 
nity cases for thirty days. Nevertheless she often 
has acquired skill and experience with constant 
practice. Some monthly nurses, indeed, are very 
capable, and many are adaptable and able to carry 
out the doctor's orders in an intelligent manner. 
Frequently, however, they are filled with wrong 
ideas and queer, old-fashioned notions about the 
care both of mother and baby. Oftentimes they 
feel their experience to be of such great impor- 
tance that they pay no attention to the advice or 



140 PREPARATIONS FOR CONFINEMENT 

orders of the physician; they regard the care of 
the patients as their own particular business rather 
than the doctor's. In consequence, the monthly 
nurse is often directly responsible for much injury 
to mother and child. Still she is always a great 
help in the absence of any one better, and she is 
all the majority of women are able to afford. 

The selection of a nurse demands careful con- 
sideration. The woman must be known to be 
competent. It is not safe to employ a woman 
who is not known. Often the physician is able 
to recommend some one in whom he has confi- 
dence. In addition to ability, certain favorable 
personal qualities are desirable in a nurse. She 
ought to be able to adapt herself to circumstances, 
to improvise when she cannot procure the object 
she requires. The possession of tact will enable 
her to get along with the family and the servants. 
Honesty and honor are two necessary traits : the 
first, because the nurse sometimes is almost in 
charge of the house and always has access to 
every part ; the second, because there is no family 
secret kept from the nurse, no skeleton she does 
not see. 

The Nurse's Duties. 

The duties of the nurse comprise everything 
that has to do with the care of both patients. She 



PREPARATIONS FOR CONFINEMENT 141 

tends to the mother, washes her, arranges her 
meals, and so on, and at the same time takes 
charge of the baby, bathing it and caring for it 
in every way. 

The nurse, ordinarily, does not perform any 
work outside of her own particular duties. She is 
not expected to wash the baby's clothes, with the 
exception of the diapers and flannels, nor wash 
her own garments, nor do the general cooking or 
sewing or cleaning. She may do all these, how- 
ever, if she be so disposed, or if she be engaged 
with that understanding. The patient's meals, 
however, she is supposed to prepare. Where no 
servants are kept, the monthly nurse often pre- 
pares the meals for the family, and when not 
engaged in caring for her patients may tend to 
some of the other household duties. 

The nurse must be properly cared for, in order 
that she maintain her own health as well as keep 
at the highest point of efficiency. Provision 
should be made for her obtaining sufficient sleep 
and getting some outdoor exercise every day. It 
is in relieving the nurse at such times that solici- 
tous relatives can be of most service. 

The nurse is usually engaged several months 
before the expected confinement. At this time all 
arrangements about the work to be done and the 



142 PREPARATIONS FOR CONFINEMENT 

compensation to be received can be definitely- 
settled. 

As the day for the confinement approaches, it is 
important for the nurse to be within reach, and a 
few days beforehand, especially if the patient has 
already borne children, she should go to the house 
and remain there until after the confinement. If 
competent, she will be able to recognize the signs 
of labor and to know when to send for the 
physician. As soon as the process has begun she 
arranges the bed and prepares the patient. 



CHAPTER XVIIL 



CHILD-BIRTH. 



Causes of Labor. How to Calculate the Day of Confinement. 
The Duration of Pregnancy. Methods of Calculation. 
Importance of Knowing the Date of the Last Menstrua- 
tion. Child-birth or Labor. The First Stage of Labor; 
the Second Stage; the Third Stage. The Puerperium. 
Afterpains. Difficulty of Urination. Changes in the 
Breasts. 

As has been told in previous chapters, when the 
pollen from the stamens of the apple blossom falls 
upon the pistil and is carried to the ovary, it 
fertilizes the ovule that lies within. The ovary 
thereupon grows bigger and bigger, developing 
into the fruit which contains the seeds from which 
are to spring new apple trees. As the apple 
becomes fully ripened, certain degenerative 
changes occur in the stem supporting it, which 
makes its connection with the parent branch so 
frail as to be easily broken. A breath of wind 
will then cause it to fall to the ground. 

The phenomena that occur in animals are much 
similar. As the ovum which contains the unborn 
(143) 



144 CHILD-BIRTH 



offspring reaches full maturity, it becomes sepa- 
rated more or less from the wall of the uterus by 
means of a degenerative process, and is finally 
expelled, in human beings after forty weeks. 

Causes of Labor. 

Every four weeks, as has been described, the 
womb has a tendency to contract. In the non- 
pregnant uterus this results in the expulsion, in 
the form of the menstrual flow, of the blood that 
has accumulated there. During the development 
of the child this monthly tendency is hardly 
noticed until the end of the tenth lunar month, 
when the separation between the ovum and the 
womb is complete. By this time the distension of 
the uterus has become so great that the slightest 
additional impulse stimulates it to contraction. 

When a ship is ready to be launched, a single 
blow from a hammer will start it down the ways. 
So with the uterus, when at the end of two hun- 
dred and eighty days it has been overstretched 
with a ripened ovum, the occurrence of the 
monthly contraction — or a little extra exercise, or 
a dose of purgative medicine, or a jolt, or a jar — 
will be sufficient to stimulate it to expel its con- 
tents. In this manner pregnancy is terminated by 
the birth of the child. 



CHILD-BIRTH 145 



How to Calculate the Date of Confinement. 

It is important for a woman to be able to esti- 
mate with some degree of accuracy on what day 
she will be confined. All her preparations are 
made in accordance with this calculation. The 
nurse is engaged for a certain date. The physi- 
cian arranges his work so as to be ready for a 
call at the expected time. Not only is much 
unnecessary trouble and annoyance given to 
mother, doctor and nurse by lack of accuracy in 
calculating the date of the confinement, but the 
baby may come at a time when no preparations 
have been made for its reception. 

'The Duration of Pregnancy. 

Confinement is said to occur about two hundred 
and seventy-one days from the date of conception. 
As it is impossible to determine accurately just 
when conception occurs, it is customary to make 
the calculations from the menstrual period imme- 
diately preceding conception. Labor may usually 
be expected to begin two hundred and eighty 
days after the first day of the last menstruation. 
Pregnancy, therefore, lasts about forty weeks, or 
ten lunar months of twenty-eight days each, or a 
little over nine calendar months, It is thus seen 
10 



146 CHILD-BIRTH 



that labor comes on at the tenth menstrual period 
from the beginning of pregnancy. 

Methods of Calculation. 

A very common way of calculating the date on 
which confinement may be expected is to start 
with the first day of the last menstruation, count 
backwards three months, and then add seven days. 
For example, if the first day of the last menstrua- 
tion was on May ioth, counting three months 
backward would bring it to February ioth, and 
adding seven days would make February 1 7th the 
date on which confinement may be expected. 
This method will give only an approximate result, 
inasmuch as months are not of equal length. This 
difficulty is overcome by adding six days in April 
and September, five days in December and Jan- 
uary and four days in February. 

Various tables have been compiled to make the 
computing more accurate as well as simpler and 
easier. One commonly used is given on the fol- 
lowing page. This table is divided by horizontal 
lines into twelve parts, one for every month in 
the year. In each compartment are two rows of 
figures, the upper one being the days of the month 
in their regular order. To determine the prob- 
able day of confinement, find in this upper row the 



CHILD-BIRTH 147 



date of the first day of the last menstrual period; 
the figure immediately below it is the day of the 
month on which labor may be expected, the month 
itself being designated in the margin. For 
instance, if the last menstrual flow began on 
March 9th, the woman will probably be confined 
on December 14th. 

In these methods of reckoning, the date ob- 
tained must be regarded only as an approximate 
one. Labor may occur within the week preced- 
ing or the w r eek following that date. It is the 
exception rather than the rule for labor to occur 
exactly in two hundred and eighty days. This 
figure is based on the supposition that menstrua- 
tion occurs every twenty-eight days. 

The best way to estimate the duration of preg- 
nancy is to ascertain the number of days between 
the last normal monthly period and the one pre- 
ceding it, and multiply this number by ten. 

As the time of confinement is calculated from 
the first day of the last menstruation, it is most 
important for the woman to know just when this 
flow last occurred. Many women, especially 
those about to be confined for the first time, fail 
to remember the exact date, thereby causing 
much worry and annoyance to themselves, to 
their family, and to the physician. 



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CHILD-BIRTH 149 



The physician is able to estimate the stage of 
pregnancy by noting the position of the womb. 

Child-birth or Labor. 

Labor is that natural process by which a 
woman expels from her uterus and vagina the 
matured ovum. This ovum, at the end of two 
hundred and eighty days, consists of the fully 
developed child, surrounded by the membranes, 
at one end of which is the placenta. 

Labor is divided into three stages. During 
the first stage the birth-canal expands until it is 
of a sufficient size to allow the child to pass 
through. The second consists in the expulsion 
of the child. In the last the rest of the ovum — 
the membranes and the placenta — is delivered. 

Before labor begins, the child usually lies head 
downward in a sack filled with water, the walls 
of the sack being formed by the membranes, 
which are everywhere in contact with the inner 
surface of the womb. The water contained in 
the sack and surrounding the child is called the 
liquor amnii, familiarly spoken of as "the waters." 

At the upper part of the uterus, between it and 
the membranes, is the placenta, which connects 
the large blood-vessels of the mother wnth the 
vessels in the umbilical cord. 



150 CHILD-BIRTH 



Before labor begins the lower part of the womb 
is narrow, the neck is stopped up with a large 
plug of tenacious mucus, and the internal mouth 
or os is tightly closed. 

The First Stage of Labor. 

Labor begins with a series of contractions of 
the womb, lasting about a minute and re-occur- 
ring at intervals of from five minutes to half an 
hour at first, usually of about fifteen minutes. 
The intervals decrease as labor progresses, finally 
being reduced to only two or three minutes. 

The contractions drive the waters down 
through the internal mouth into the neck of the 
uterus, where, covered only by the thin mem- 
branes, they dilate the neck and the internal 
mouth easily and gently. As with repeated con- 
tractions the womb becomes smaller and smaller, 
the head of the child is driven down in the same 
direction as the bag of waters and further dis- 
tends the lower part of the uterus and its neck, 
until at last the neck has been stretched so wide 
as to be completely obliterated. The same force 
then proceeds to dilate the outer mouth, or ex- 
ternal os, until the latter is big enough to let the 
head through. 

Just as this occurs, the membranes bulging in 



CHILD-BIRTH 151 



front usually rupture, allowing the waters to 
escape. Sometimes the membranes are so tough 
that they have to be punctured. When the child 
is born with the unbroken membranes around it, 
it is said to be born with a caul. In some cases 
the membranes rupture early, causing what is 
known as a dry labor. With the full dilatation 
of the external os, the first stage ends and the 
second begins. 

The Second Stage of Labor. 

During the second stage of labor the head 
descends through the vagina, advancing slowly 
and stretching all the tissues before it. Now, not 
only does the uterus contract, but the abdominal 
muscles also are brought into play and help to 
drive the child downward through the birth- 
canal. The moulding and stretching of the parts 
to -fit the child usually takes about an hour and a 
half or two hours. 

At the end of this time the whole birth-canal 
will have been fully dilated. The vulva, or ex- 
ternal opening, then begins to distend, and when 
the aperture is sufficiently large, the head passes 
through, followed shortly after by the rest of the 
body. With the birth of the child the second 
stage ends. 



152 CHILD-BIRTH 



The Third Stage of Labor. 

After the expulsion of the child the uterus 
continues to get smaller. As the uterus contracts, 
the placenta becomes detached from it and lies 
within the womb until, with further contractions, 
it is finally driven out into the distended cervix 
or into the vagina, with the membranes attached 
to it and trailing after it. Occasionally the mem- 
branes remain adherent to the uterus and must be 
separated by the physician. 

Having expelled the placenta, the uterus con- 
tracts until its cavity is obliterated. It then 
remains firmly contracted, squeezing the ends of 
the blood-vessels that were broken when the pla- 
centa was torn loose, and thus preventing hem- 
orrhage. Labor itself terminates with the ex- 
pulsion of the placenta or after-birth. 

The Puerperium. 

The period immediately following the delivery 
of the child and the after-birth, comprising the 
time consumed by the uterus in regaining its nat- 
ural size, is spoken of as the puerperal state, puer- 
perium, or lying-in period. In a normal case it 
lasts six weeks. 

The process by which the womb becomes re- 
duced directly after labor to the size of the 



CHILD-BIRTH 153 



healthy, non-pregnant organ is called technically 
"the involution of the uterus/' It is brought 
about by shrinking of the tissues of the womb, 
part of them becoming converted into fat and 
being expelled with the discharges. 

This discharge, which always occurs after 
labor and is called the lochia, consists of blood, 
degenerating tissue, and the normal secretion of 
the parts. For the first five days it is red in color, 
during the next two days becoming yellow, then 
assuming a whitish color. This last stage lasts 
until the seventh to the fourteenth day, or even 
longer. 

The amount of the discharge is conveniently 
estimated by noting the number of napkins or 
pads soiled in the twenty-four hours. These 
pads for the first four or five days should not 
normally have to be changed oftener than six 
times in the twenty-four hours. 

The odor of the discharge is an index as to the 
condition of the patient. It should resemble that 
of fresh blood or raw meat while the discharge 
is red, but thereafter it should be that peculiar to 
the parts. When decomposition occurs the odor 
becomes putrid. This is an important danger 
signal. When it occurs the physician must be 
notified at once ; the woman's life may be in peril. 



154 CHILD-BIRTH 



After-pains. 
For several days after labor in women who 
have already borne children the muscle of the 
uterus relaxes a little at times. This loosens the 
hold on the broken blood-vessels and permits 
them to bleed slightly. The blood that oozes out 
in this manner collects in the uterine cavity where 
it forms clots of considerable size. These clots 
act as an irritant to the womb, exciting it to 
active contractions in an effort to expel them. 
The contractions of the uterus cause • pains or 
cramps, which are known as after-pains. 

Difficulty of Urination. 
The muscles of the abdomen are so worn out 
and strained after labor that sometimes for sev- 
eral hours or days they cannot act in emptying 
the bladder, which organ consequently becomes 
distended and must sometimes be relieved by 
means of a catheter. This may be used only by 
a physician or graduate nurse, and only after 
the failure of the various expedients to induce the 
voiding of urine voluntarily, described in Chapter 
XX, on "The Care of the Mother After Labor." 

Changes in the Breasts. 
During the latter part of pregnancy a thin, 
glistening fluid, called colostrum, is found in the 



CHILD-BIRTH 155 



breasts, from which it may be squeezed out. Di- 
rectly after labor it is increased in quantity and 
becomes a little whiter and more opaque. At the 
end of about forty-eight hours the breasts un- 
dergo a decided change; they suddenly enlarge 
and may become very tense. Sometimes they are 
painful and tender on pressure, and impart a hard 
and lumpy sensation to the touch. The veins 
under the skin enlarge and show very distinctly. 
Instead of colostrum, the breasts now contain 
normal human milk. 



CHAPTER XIX. 



THE MANAGEMENT OF LABOR. 

The Diagnosis of Labor. Duration of Labor. A Talk on 
Germs. Infection of the Birth Canal. Prevention of 
Puerperal Infection. Surgical Cleanliness Throughout 
Labor. The Management of the First Stage of Labor. 
Management of the Second Stage. Care of the New- 
born Infant. Treatment of an Asphyxiated Baby. 
Care of the Mother During the Third Stage of Labor. 

It is not the author's purpose in this chapter 
to write a treatise on obstetrics. Nor is it his 
intention to so instruct a woman that she will be 
qualified to assume full charge of a labor. It 
must not be supposed that with a few minutes' 
reading a person can become proficient in what 
requires years of study and practice to acquire. 
The delivery of the child is too serious a proce- 
dure to be entrusted to any but the most skilful 
hands. A physician should be engaged whenever 
possible; next in order of proficiency come the 
medical student and the midwife. 

In assisting the physician, however, a woman 
can be of great service, especially if she is familiar 
(156) 



THE MANAGEMENT OF LABOR 157 

with the work required of her. The present 
chapter will be devoted to instructing a woman 
in the requisite knowledge that will make her 
presence valuable in the lying-in room. 

Before the date of the expected confinement, 
which is to be calculated according to one of the 
methods given, the preparations for it mentioned 
in Chapter XVII must be made. The occlusive 
bandages, the abdominal binder and the other 
articles required, including the baby's clothes and 
the baby's basket, should be in readiness. 

The Diagnosis of Labor. 

It is important for a woman to be able to recog- 
nize when she is in labor, in order, on the one 
hand, to summon the physician in time, and on 
the other, to avoid ludicrous mistakes. 

A valuable premonitory sign is the "drop- 
ping," or sinking of the child's head in the pelvis, 
which is associated with a flattening of the upper 
part of the abdomen and a greater prominence 
of the lower portion. This may occur over night 
at the beginning of the last month of pregnancy 
in women who have never borne children, and 
two weeks or less before labor in a woman who 
is already a mother. 

The sign that labor has actually begun is the 



158 THE MANAGEMENT OF LABOR 

occurrence of labor pains. These are of a char- 
acteristic duration, situation and nature. They 
last but a minute and are separated by intervals 
of from five minutes to half an hour, being 
usually about fifteen minutes apart. The pain 
is felt in the abdomen or in the back, or it may 
seem to pass from the navel to the spine. 

As the neck of the womb stretches, there is a 
slight oozing of blood which stains the large plug 
of mucus that fills the cervical canal. With the 
further dilatation of the neck or cervix this 
blood-stained plug of mucus is expelled, when 
it is know as the "show." 

Duration of Labor. 

It would be a most desirable thing if one were 
able to estimate just how long a labor will last. 
This, however, cannot be done with any degree 
of accuracy. The duration may vary from one 
hour or less to many hours and in rare instances 
to a week or more. Women who have already 
borne children are in labor on an average about 
eight hours; those having their first baby must 
expect to be confined double that time or longer. 
The probable length of time may often be judged 
from the history of a woman's previous labors. 
The process is often much shortened in a strong, 



THE MANAGEMENT OF LABOR 159 

healthy woman who has lived hygienically and 
has taken plenty of exercise, especially if she has 
practiced those movements that strengthen the 
abdominal muscles. 

A Talk on Germs. 

Disease germs or bacteria are very minute; 
thousands can be present on the head of a pin 
without being seen with the naked eye. These 
microscopic organisms multiply with great ra- 
pidity ; in the course of several hours two or three 
individuals can increase to billions. Whenever 
disease germs get inside the body they manu- 
facture a poison which may produce disease and 
even cause death. While dangerous wherever 
found, they are especially so in certain localities, 
such as the interior of the womb and of the abdo- 
men, in the latter place giving rise to peritonitis. 

The introduction of a disease germ into the 
body is called infection. The presence of such a 
germ in the body is known as sepsis. Any article 
that has a germ on it is said to be infected or 
septic. By disinfecting or sterilizing an object 
we remove all germs from it and render it aseptic, 
sterile or surgically clean. There is consequently 
an important difference between ordinary cleanli- 
ness and surgical cleanliness. The former signi- 



160 THE MANAGEMENT OF LABOR 

fies that all dirt has been removed ; the latter that 
all germs as well as dirt are absent. 

Infection of the Birth Canal. 

Disease germs are never normally present in 
any of a woman's organs of generation. They 
must come from without. When present in any 
part of the birth canal they have as a rule been 
introduced by the finger or hand, by an imple- 
ment or instrument, or by water. They can, 
however, themselves effect an entrance if de- 
posited upon the external parts by one of the 
agents mentioned or by the bed linen, the body 
clothing, the mattress, the vulvar pads or by the 
material used to wash the vulva or external parts 
(rags, cloths, sponges, cotton, etc.). As soon as 
any germs have been introduced into the birth 
canal they are likely to multiply and cause both a 
local inflammation and a poisoning of the whole 
system. Such a condition occurring after labor 
is known to physicians as puerperal infection, 
puerperal sepsis or puerperal fever, and more 
popularly as child-bed fever or blood poisoning. 

At any time other than during labor or shortly 
after it, the introduction of germs into the va- 
gina is not attended with such serious results, be- 
cause the cervix or neck of the womb is usually 



THE MANAGEMENT OF LABOR 161 

tightly closed and shuts off the germs from the 
parts above. But during the period from the 
beginning of labor, when the cervix begins to 
dilate, to the end of the puerperium, when it has 
firmly contracted again, a germ can easily travel 
through the open neck, then out the tube, finally 
entering the abdominal cavity. In the womb the 
germ produces a septic inflammation ; in the tube 
it may cause an inflammation, going on to the 
formation of an abscess known as a pus tube; in 
the abdomen it will set up a peritonitis. All 
these conditions give rise to blood poisoning. 

The Prevention of Puerperal Infection. 

Knowing how child-bed fever is caused, it is 
possible to prevent it. If germs are never intro- 
duced into the birth canal they can do no damage 
there. The entrance of germs is prevented by 
not inserting into the vagina of a woman in labor, 
or even bringing in contact with the parts, any- 
thing that is not surgically clean. Some women 
indeed are lucky and may have germs introduced 
without suffering any evil consequences. But the 
majority are bound to pay the penalty. Most 
of the deaths that have occurred during or shortly 
after child-birth have been caused by puerperal 
infection, a preventable disease. If a woman 

ii 



162 THE MANAGEMENT OF LABOR 

should regard the precautions given in this chap- 
ter as being too troublesome and "fussy/' let her 
reflect that they save human lives. Anything less 
is fraught with danger. No better picture of the 
result of carelessness and negligence can be given 
than the one presented by the physician and man 
of letters, Oliver Wendell Holmes. 

"It is as a lesson/' he says, "rather than as a 
reproach, that I call up the memory of the irrep- 
arable errors and wrongs. No tongue can tell 
the heart-breaking calamity they have caused. 
They have closed the eyes just opened upon a 
new world of love and happiness; they have 
bowed the strength of manhood into the dust; 
they have cast the helplessness of infancy into the 
stranger's arms, or bequeathed it, with less 
cruelty, the death of its dying parent. There is 
no tone deep enough for regret, and no voice loud 
enough for warning." 

Surgical Cleanliness Throughout Labor. 

The only way to prevent puerperal infection is 
to keep disease germs out of the woman's vagina. 
This is accomplished by observing surgical clean- 
liness or asepsis. Nothing that is not sterile must 
enter the birth canal. In addition to this there 
must be ordinary cleanliness in everything con- 



THE MANAGEMENT OF LABOR 163 

cerning the woman. It is partly on account of 
their knowledge of asepsis that the physician is 
to be preferred to the midwife and the trained 
nurse to the monthly nurse. 

It is necessary to follow rigorously all the 
directions given in Chapter XVII concerning the 
preparations for the confinement. The room, 
the bed and the dressings are to be made ready 
in the manner described. The rules laid down in 
this and the following chapter must be obeyed 
to the letter. Only water that has been boiled 
may be used about the patient, even when it is 
to be made up into a disinfectant solution. All 
articles that come in contact with a woman in 
labor should be boiled for at least five minutes, or 
if boiling would injure them they should be im- 
mersed for half an hour in a disinfectant solution, 
such as bichlorid of mercury I to iooo or car- 
bolic acid i to 20. 

But it is not sufficient that everything employed 
about a woman in labor be rendered aseptic; it 
must be kept so. The moment a sterile object 
touches something that is not sterile the object 
is itself no longer sterile, but has become infected. 
An instrument that has been boiled remains 
aseptic or sterile if held in a hand that has been 
sterilized, but when touched by a hand that has 



164 THE MANAGEMENT OF LABOR 

not been rendered sterile it is no longer surgically 
clean. Consequently, before they can touch any 
object or any part of the patient which is to re- 
main sterile, the hands themselves must first be 
sterilized. 

A common and efficient method of sterilizing 
the hands is to scrub them for ten minutes with 
a nail brush, tincture of green soap and hot w r ater, 
the latter being changed several times, and to fol- 
low this by a thorough scrubbing with alcohol 
and then by an immersion for at least two min- 
utes in a i to iooo bichlorid of mercury solution. 
After this process the hands must not touch any- 
thing that is not sterile, for a hand that has been 
thoroughly sterilized becomes infected as soon as 
it touches the face or dress or any other object 
which has not been rendered aseptic. Conse- 
quently, should a person with sterile hands inad- 
vertently touch something not surgically clean, 
should she for example scratch her face or brush 
her hand against her dress, she must immediately 
immerse her hands in the bichlorid solution or 
even scrub them again before so doing. 

The Management of the First Stage of Labor. 

During labor, only the physician and the nurse 
should be in the lying-in room. Relatives and 



THE MANAGEMENT OF LABOR 165 

friends whose services are not required should be 
excluded. It is especially necessary to keep out 
those loquacious neighbors who delight in de- 
scribing serious or fatal cases which have come 
to their notice. The nurse, too, must refrain from 
alluding to any dangerous or harrowing cases she 
may have attended. 

As stated in Chapter XVII, the first step in the 
management of a labor is to give an enema of a 
pint of soapsuds containing a teaspoonful of tur- 
pentine. When gonorrhea is known, or suspected, 
to be present, the vagina should be scrubbed with 
soap and water and then douched with a I to 2000 
bichlorid solution. Under ordinary circum- 
stances, however, a douche is undesirable. The 
hair may be brushed and arranged in two braids. 
After the bath, given as directed in Chapter 
XVII, the patient is dressed in a clean nightgown, 
wrapper and easy slippers. In cold weather she 
wears in addition a thin woolen undershirt and 
woolen stockings. 

In the daytime the woman may then be up and 
about, walking about the room, sitting in a chair, 
or lying on a lounge. During a pain she may 
obtain some relief by lying down or sitting with 
the body inclined forward, the hands grasping a 
chair in front. At night it is better for the 



166 THE MANAGEMENT OF LABOR 

woman to sleep. She is usually ordered to bed 
when the physician finds upon internal examina- 
tion that the external os or mouth has reached the 
size of a silver dollar, although he often waits 
until the os is fully dilated. After this time the 
woman should never sit on a closet, but should 
always use a vessel of some sort. 

In this first stage pressure on the end of the 
spine during a pain will give decided relief and 
will tend to shorten the labor. By leverage press- 
ing on the tip of the last bone of the spine forces 
out the upper portion of this bone, thus affording 
more room for the head to enter the pelvis. 

When labor comes on in the daytime, it is 
necessary at frequent intervals to supply liquid 
nourishment, such as milk, broths and the like, 
with a very small quantity of bread, toast or 
crackers. The woman should drink large quanti- 
ties of water, plain or effervescent, and may be 
allowed a moderate amount of tea and coffee. 

Many physicians make a practice of giving an 
anesthetic when the pains become severe. Ether 
is the safest anesthetic. Ordinarily it is employed 
not to put the woman to sleep, but merely to 
obtund the sense of pain. Ether must not be 
given too long; consequently it is administered 
as late in the labor as possible, being usually de- 



THE MANAGEMENT OF LABOR 167 

ferred until the second stage, when the abdominal 
muscles are brought into play. It is important 
not to give too much ether; therefore the anes- 
thetic is not given until just as the pain is coming 
on. A light towel is then thrown over the face, 
and as the patient exhales, a few drops are poured 
on the towel just below the tip of the nose, so 
that the vapor is sucked into the lungs as the 
patient breathes in. It takes only a little ether 
to obtund the sensibilities, and no more should be 
given than is necessary for this. As soon as each 
pain passes off the administration of ether is sus- 
pended, to be assumed with the onset of the next 
pain. 

The Management of the Second Stage of Labor. 

As the second stage draws near, a large, clean, 
new sponge or some clean towels should be at 
hand to catch the waters when they break. With 
the advent of this stage of labor and the participa- 
tion in it of the abdominal muscles the woman 
will want something to pull on to aid her in her 
bearing-down efforts. To supply this need a 
"puller" may be made by tying a twisted sheet, 
a roller towel, or a rope to the foot of the bed. 
The woman pulls on this while she braces her 
feet against the footboard of the bed. 



168 THE MANAGEMENT OF LABOR 

During the bearing-down pains of the second 
stage, decided relief is afforded by pressure made 
in the small of the back or by a small, hard pillow 
or a hard roll of some material placed there. This 
acts in an opposite manner to the pressure that 
is applied during the first stage. Forcing in the 
upper portion of the last bone of the spine springs 
out the lower end and allows more room for the 
head to leave the pelvis. Suffering is considera- 
bly lessened thereby and the labor is shortened. 

This probably explains why the patient often 
feels better when the small of her back is pressed 
upon by the nurse or rubbed briskly or when a 
hot water bottle is applied to it. Occasionally 
washing the patient's face and hands with cold 
water will prove very grateful. A cramp in the 
leg may be relieved by forcibly stretching out the 
limb, at the same time pulling the foot up toward 
the knee. 

As the time of actual delivery approaches, the 
nurse or attendant must see that everything is at 
hand. The patient is placed in the desired posi- 
tion on her back or side. If on the latter, a clean 
pillow should be placed between the knees, or the 
upper limb should be supported by the nurse. A 
sterile obstetric pad is then placed beneath the 
hips and a sterile sheet is draped over the side of 



THE MANAGEMENT OF LABOR 169 

the bed or pinned around the waist with the side 
next the accoucheur left open and the long end 
fastened beneath the patient's arm. The phy- 
sician should have within easy reach a basin con- 
taining a disinfectant solution for his hands and 
another basin containing bits of cotton in an 
antiseptic solution. Near by should be the ma- 
terial for tying the cord and the scissors for cut- 
ting it, all of which must be sterile ; a glass con- 
taining a warm solution of ten grains of boric 
acid to the ounce of water, pieces of soft linen 
and a medicine dropper ; and a bottle of fluid ex- 
tract of ergot, with a teaspoon. Many physicians 
also like to have in readiness a sterile douche bag, 
with sterile hot and cooled water and an aseptic 
bath thermometer. 

A warmed blanket must be at hand in which 
to receive the baby. Hot and cold water, which 
need not be sterilized, should be easily available 
in tubs, basins or buckets, for resuscitating the 
infant in case it be asphyxiated. 

Inasmuch as the actual delivery is the work of 
the physician and of him alone, a description of 
it here would be out of place. Suffice it to say 
that the skill of an accoucheur consists in prevent- 
ing tears and other accidents and in meeting the 
various complications as they arise. 



170 THE MANAGEMENT OF LABOR 

As soon as the baby's head is delivered the eyes 
are wiped with a piece of soft linen soaked in the 
boric acid solution, more of the solution being 
introduced later with a medicine dropper. 

Care of the New-Born Infant. 

Immediately after birth the baby is held by its 
thighs and legs, head downward, while the phy- 
sician crooks his little finger, covered, or not, 
with a piece of old linen and introduces it in the 
baby's throat back of the tongue, so as to clear 
the air passages of any blood or mucus that may 
have been inspired during the passage through 
the birth canal. The infant is then wrapped in 
a warmed towel and laid upon its right side with 
its face turned away from its mother. As soon 
as the umbilical cord has ceased to beat it is tied 
about two fingers' breadth from the child's body 
with a firm double knot, the ends of the string 
being then tied first with a single and then 
with a bow knot. The physician next places his 
hand upon the baby's abdomen so that the cord 
lies between the fingers, and holding the scissors 
close to those fingers with his other hand, cuts 
the cord off on the outer side of the knot. The 
child is then wrapped in a warm blanket and put 
in a safe place, preferably its basket or crib. 



THE MANAGEMENT OF LABOR 171 

A premature child is best cared for in an incu- 
bator. Where one is not at hand a clothes basket, 
bath-tub, or wooden box may be used. This should 
be lined first with heavy wrapping paper and then 
with heated cotton or blankets and filled for half 
its depth with cotton wool. The child is laid in 
this and surrounded with hot water cans or bot- 
tles, and covered all but its face and bottom with 
lamb's wool, cotton wool or cotton batting, held 
in place by gauze bandages. A piece of absorbent 
cotton or wool should be placed between the 
child's thighs. A blanket or shawl then covers 
the basket with the exception of the baby's head. 
The incubator is to be kept at a temperature of 
between 85 and 95 degrees Fahrenheit 

Treatment of an Asphyxiated Baby. 

If the child does not breathe after birth, the 
cord should be immediately tied and cut as de- 
scribed above, and one of the following methods 
of inducing artificial respiration, or all in succes- 
sion, should be tried. The child may be alter- 
nately folded and unfolded like a book. It may 
be supported by the feet, with the forehead rest- 
ing on a table, while light compression with the 
thumb and fingers is made on its chest about 
twenty times a minute. Wrapped in a towel and 



172 THE MANAGEMENT OF LABOR 

grasped by the shoulders, the baby may be swung 
first between the physician's knees and then over 
his shoulders. Another method is to stretch the 
baby's arms high above its head and then press 
them down to its sides. The child's neck may t e 
placed over a mug, and through a clean towel 
spread over the child's face the physician may 
very gently blow a little air into the child's mouth. 
Slapping the buttocks and rubbing the back and 
chest vigorously may start the breathing. The 
infant should frequently be placed in a hot bath 
to prevent chilling. While in such a bath ice 
water may be poured on the chest and abdomen. 
Sometimes the shock of placing the baby alter- 
nately in hot and cold water will stimulate the 
respirations. 

Care of the Mother During the Third Stage of Labor. 

Meanwhile the mother must be receiving at- 
tention. As soon as the child's body is born she 
is given a teaspoonful of the fluid extract of ergot 
in a little water. At the same time the womb is 
grasped through the abdominal wall, with the 
thumb in front and the fingers behind, and is 
rubbed, kneaded, squeezed and pressed upon to 
stimulate it to contract and thus prevent hemor- 
rhage. After a while the uterus will be felt to 



THE MANAGEMENT OF LABOR 173 

contract firmly. Then during a pain the physician 
presses down the womb and squeezes out the 
after-birth. The kneading and pressing are con- 
tinued for fifteen minutes more. All the soiled 
towels and pads are then removed, the parts 
cleaned, and those sheets known as "the tem- 
porary bed" slipped out. A sterile, folded, dry, 
warmed sheet, or another sterile obstetric pad, is 
then placed under the patient. A pad, or com- 
press, consisting of one or two folded towels, is 
laid above the navel, and the binder is adjusted 
so as to reach from the ribs to the hip bones, 
being pinned from above downward so as to fit 
snugly. Then with surgically clean hands the oc- 
clusive bandage is applied between the thighs and 
pinned to the binder both in front and behind. 



CHAPTER XX. 



THE CARE OF THE MOTHER AFTER LABOR. 

Rest and Quiet. Hygienic Regime. Rules Concerning 
Urination. Attention to the Bladder and Bowels. 
Care of the Breasts. Congested and Distended Breasts. 

The chief concern of both physician and nurse 
in charge of a woman after labor is the preven- 
tion of infection. This is attained by the same 
precautions in regard to surgical cleanliness as 
were necessary during the labor itself. Absolute 
cleanliness of the patient, of every one who at- 
tends her and of everything that comes in contact 
with her, will usually avert the commonest and 
most fatal complication of this period — puerperal 
sepsis. This is by far the most important consid- 
eration. There are other matters, however, which 
add to the comfort and safety of the patient. 

The life of the woman requires careful regu- 
lation both during the period immediately follow- 
ing labor and throughout the whole of lactation. 

The character of her milk is affected by her 
mode of living. 

(174) 



CARE OF MOTHER AFTER LABOR 175 

Rest and Quiet. 

Absolute mental and physical rest is necessary 
for the first few days after labor. The patient 
must not be disturbed by loud noises or by a glar- 
ing light. For these first few days no extended 
conversation should be allowed in the lying-in 
room. 

After delivery it is customary for the woman 
to lie flat on her back, for the first six hours with- 
out a pillow. As soon as she feels rested and 
comfortable and there is no longer any danger 
from hemorrhage or relaxation of the womb, she 
may move about in bed, turn on either side or 
lie upon the abdomen, and after several days the 
shoulders may be raised a little. She is then 
gradually propped up higher in bed until in a 
few days she can be placed- in a sitting position. 

The patient should be kept in bed until the 
womb has so shrunken in size that it has again 
returned to the pelvis, and until there is no longer 
any blood in the lochial discharge. This state 
usually is reached in from ten to fourteen days. 
A safe rule would be for the woman to remain 
strictly confined to the bed for two weeks. If she 
gets up beforehand her womb is liable to be dis- 
placed. After the fourteenth day she may put on 
stockings, bedroom slippers and a flannel wrap- 



176 CARE OF MOTHER AFTER LABOR 

per and pass the day upon a lounge, rising to use 
the commode and sitting up as long at a time as 
she can without fatigue. In many cases she does 
not walk about the room for a week longer or go 
down stairs until the end of the fourth week. 
These directions, however, are subject to varia- 
tion, to suit the individual case. 

The only visitors to be allowed in the lying-in 
room are the patient's husband and mother, who 
must not come too frequently, and may remain 
for but a short time, being careful to avoid ex- 
citing subjects in their conversation. All others 
are to be excluded during the first week. After 
this period the patient's relatives and intimate 
friends may see her for a few minutes, if they be 
of cheerful disposition. But the nurse must keep 
out those inquisitive "busy-bodies" who often 
come pouring into the room inquiring minutely 
as to the particulars of the case and offering sug- 
gestions and advice based on their experience with 
cases which they believe to have been similar and 
which they want to describe in detail. 

Hygienic Regime. 

The diet during the first three days should be 
very light, consisting chiefly of milk, with the 
addition of toast or crackers, gruel mush, grits or 



CARE OF MOTHER AFTER LABOR 177 

boiled rice and a little stewed fruit or baked ap- 
ples. Gradually, during the first week, soft-boiled 
eggs, custard, junket, light puddings, broths, 
soups, jelly, sponge cake, ice cream, a charlotte 
russe, fresh fruit and vegetables are added to the 
dietary. The white meat of fowls, sweetbread, 
lamb chops, fish and oysters may be given during 
the second week, and beef, bacon and potatoes 
during the third week. The puerperal woman 
must avoid rich and indigestible foods and alco- 
holic drinks. It is necessary throughout the 
whole of lactation, the period during which she 
nurses her baby, for the mother to be careful to 
eat only what is digestible and nutritious. 

Regular exercise in the open air is also im- 
portant, care being taken to keep the nursing 
mother, so far as possible, free from fatigue, both 
mental and physical, and also from worry, anx- 
iety or nervous excitement. Late hours are al- 
ways to be avoided. Inasmuch as a powerful 
emotion, such as fright or violent anger, may 
render her milk unfit for use, a woman who has 
been subjected to such an influence should avoid 
nursing her baby for some hours afterward, 
emptying her breasts by means of a breast pump 
and giving the child barley water for one or 
two feedings. 

12 



178 CARE OF MOTHER AFTER LABOR 

In the morning, about an hour after breakfast, 
the patient is bathed in tepid water with a w r ash- 
rag and soap. In the evening she may receive 
a light alcohol rub. 

The genital region should be cleansed and 
dressed every four hours and after each evacua- 
tion of the bladder or rectum. The nurse, after 
seeing that everything she requires is at hand, 
places the patient on a douche pan and arranges 
the coverings. She then sterilizes her hands and, 
gently separating the labia, pours on the parts 
from a pitcher a disinfectant solution, such as a 
i to 2000 bichlorid solution. The parts are then 
dried with bits of sterile cotton, and a fresh 
sterile occlusive dressing, made as described in 
Chapter XVII, is applied, being held in place by 
a T bandage or by pinning its ends to the abdom- 
inal binder. 

Attention to the Bladder and Bowels. 

After labor there frequently is a tendency to 
retention of urine. If the woman is unable to 
pass her urine, relief may sometimes be obtained 
by placing her on a w r arm bed pan or douche pan 
half full of warm water. If this fails, a hot ap- 
plication, such as a turpentine stupe, may in 
addition be made over the kidneys, bladder or ex- 



CARE OF MOTHER AFTER LABOR 179 

ternal parts, or a clean sponge or a large piece of 
cotton, wet with warm sterile water, placed 
between her thighs, or the patient may listen to 
the sound of running water. Often if left to her- 
self the patient is better able to urinate, Some- 
times if raised by means of pillows to a semi- 
recumbent or a sitting position she can then 
empty her bladder. If these expedients fail and 
no urine has been passed six hours after labor, 
resort must be had to catheterization. This can 
be entrusted only to the skilled hands of the phy- 
sician or the trained nurse, and must be per- 
formed aseptically with all the precautions re- 
quired by surgical cleanliness. Should any germs 
enter the bladder, they may set up an inflamma- 
tion that is very difficult to cure. After this, the 
woman is to be catheterized three times a day if 
necessary, in every instance recourse having first 
been made to each of the expedients mentioned 
above. 

Constipation is the rule after labor. At the 
end of forty-eight hours it is well to administer a 
laxative of some sort. The choice of the drug 
employed will depend upon the patient's inclina- 
tion or prejudice. Castor oil may be given in 
warm milk or in a frothy liquid, such as porter 
or soda water. A good plan is to give half a 



180 CARE|OF MOTHER AFTER LABOR 

bottle of citrate of magnesia on the evening of 
the second day after labor, and the other half 
the following morning before breakfast. If the 
bowels do not move within two hours an enema 
should be given. 

Care of the Breasts. 

The infant is nursed at regular intervals of 
two hours at first. Should the child die, mechan- 
ical measures for emptying the breasts will be nec- 
essary, a breast pump being usually employed, 
the breasts at the same time being rubbed and 
massaged with oiled finger tips in a direction to- 
ward the nipple. Sometimes the use of massage 
and the breast pump is required to supplement 
the child's sucking when the latter is not sufficient 
to thoroughly evacuate the breasts. 

The observance of care and cleanliness in re- 
gard to the breasts and nipples is the best pre- 
ventative of subsequent trouble. The breasts 
should never be handled by either the nurse or the 
patient with fingers that are not thoroughly clean. 

It is important after each nursing to wash the 
nipples by means of some absorbent cotton with 
warm or cold water and castile soap, or with a 
solution of boric acid, 10 grains to the ounce, and 
to dry them with a soft cloth. The skin of the 



CARE OF MOTHER AFTER LABOR 181 

nipple and the surrounding parts are then 
anointed with sterile olive oil or sterile cocoa but- 
ter applied by means of fresh absorbent cotton or 
a piece of clean linen. A supersensitive nipple 
may often be relieved with extract of witch hazel. 

A nipple shield will have to be used when the 
nipple becomes chapped or cracked or when it is 
very tender or of such a size and shape that the 
baby cannot obtain a satisfactory hold. A glass 
shield with a rubber nipple is the one most fre- 
quently employed. It should be simple and should 
fit tightly. If filled with warm milk and in- 
verted over the nipple the child will often take 
it better. After being used it should be boiled and 
then kept in a boric acid solution. 

A depressed nipple may be drawn out by means 
of the breast pump, suction being applied by a 
rubber bulb or by the mouth through a piece of 
rubber tubing, or a bottle may be filled with very 
hot water, emptied rapidly, and quickly inverted 
over the nipple. 

The support of the patient's breasts by means 
of the mammary binder will increase her com- 
fort and may prevent serious disturbances. There 
are many forms of this binder. The simplest is 
a straight bandage of unbleached muslin, prop- 
erly shaped by darts, applied with a compress un- 



182 CARE OF MOTHER AFTER LABOR 

der the outer portion of each breast. The 
Murphy binder is likewise made from a straight 
piece of muslin, but has a notch for the neck and 
two deeper notches for the arms. Another band- 
age can be made out of a handkerchief which is 
folded as a triangle, passed under the breasts and 
tied behind the neck, the lower end being fastened 
with safety pins to the abdominal binder or to a 
strip of muslin, or a bandage, tied around the 
waist. One handkerchief may be applied to each 
breast. The obstetrical breast support with knit- 
ted bosom is much less cumbersome and therefore 
more desirable when the patient is out of bed. 

Congested and Distended Breasts. 

When the flow of milk is excessive, the breasts 
may become distended, or even congested, despite 
all care. Congestion is apt to occur shortly after 
the breasts assume their function of supplying 
milk. Both conditions are treated by dietetic and 
other measures. A purge must always be given. 
Covering the breasts with sterile gauze will soak 
up the leakage and prevent it from soiling the 
clothing. Should the milk fail to escape, a condi- 
tion known as caked breast results. This is best 
treated by washing the breasts with soap and 
water just before the child is nursed, or the breast 



CARE OF MOTHER AFTER LABOR 183 

pump is applied, and then with aseptic hands 
gently rubbing warm sterile olive oil on them 
for ten to twenty minutes, massaging them from 
below upward and from the base toward the 
nipple. 

Preceding the massage, hot fomentations, or 
cloths soaked in lead water and laudanum, may 
be applied for fifteen to twenty minutes, care be- 
ing taken to cleanse the nipple thoroughly before 
putting it in the baby's mouth. When inflamma- 
tion or an abscess develops, the baby must be im- 
mediately taken from the breast and the physician 
summoned, 



CHAPTER XXL 



THE CARE OF THE BABY, 

The High Mortality of Infants. The New-Born Baby. The 
Baby's Weight. Regulation of the Bowels. The Baby's 
Food. Breast Feeding. Modifying the Breast Milk. 
Bottle Feeding. Bottle and Nipple. When the Bottle 
Disagrees. The Feeding of Older Children. Water. 
The Baby's Clothing. Bathing the Baby. Sleep and 
Rest. Exercise and Fresh Air. Digestive Disorders of 
Infancy. Colic. Contagious Diseases. 

A professor of children's diseases in a New 
York medical college states in a book written for 
physicians that the chief requisite to the success- 
ful treatment of children is the education of the 
mother. A well-informed mother, instructed in 
the rudiments of the child's care, is regarded by 
him as having her usefulness as a mother 
increased tenfold. 'The children of such 
mothers/' he declares, "as the result of a properly 
regulated life, have better appetites and less ill- 
ness; they are stronger and more vigorous than 
those indifferently cared for. If disease attacks 
them, they make more prompt and satisfactory 
(184) 



THE CARE OF THE BABY 185 

recoveries ; rf an operation is required, intelligent 
mothers appreciate its necessity. As children, 
their offspring are better specimens of the race, 
and as adults, they will always have reason to be 
thankful that their mothers were educated and 
efficient in child management/ ' 

The High Mortality of Infants. 

The average mother regards herself as perfectly 
competent to look after her baby. Little does she 
realize that from one-third to one-fifth of all the 
babies born alive die during their first year, ten 
per cent, before they reach the age of four weeks. 
When we reflect that most of these deaths — at 
least half — are preventable, we appreciate the fact 
that the majority of women are really ignorant as 
to the proper care of their infants. One of the 
most important duties therefore of the mother 
and of the prospective mother is to acquaint her- 
self with the hygienic management of children. 

The New-Born Baby. 

The baby's skin is red at birth and covered 
with a waxy substance, which is removed by 
smearing the baby all over with olive oil, purified 
white vaseline or washed unsalted lard, and then 
bathing it. The head at first has an abnormal 



186 ' THE CARE OF THE BABY 

shape due to the prolonged pressure it experi- 
enced in passing through the birth canal, but in 
a few days or so it resumes its normal appear- 
ance. This, however, must be left to nature, and 
no attempt made to mold the head into shape. 
Just behind the forehead the bone is absent over 
a diamond-shaped area about three-quarters of 
an inch to an inch and a quarter long and seven- 
eighths of an inch wide. This space, known as 
the anterior fontanelle, begins to close at the 
beginning of the second year and normally dis- 
appears by the twentieth month. In handling an 
infant one must be careful to avoid pressure on it. 
When the baby is poorly nourished and the system 
lacks fluid this spot is depressed. 

The Baby's Weight. 

Six to nine pounds is the average weight at 
birth. During the first five days of life an infant 
loses usually from four to six ounces and then 
gains about an ounce a day until the end of the 
second month. For the next two months the daily 
gain is about three-quarters of an ounce, after 
which a pound a month is the average gain 
throughout the rest of the first year. Five and 
one-half to seven pounds are usually added during 
the first year. 



THE CARE OF THE BABY 187 

The baby should be weighed regularly, the 
scoop and platform scale used by grocers being 
satisfactory for this purpose and inexpensive. 
When a baby does not gain on the average at 
least four ounces a week, it cannot be said to be 
doing well. A physician should then be consulted 
to determine what is at fault. 

The Bowel Function. 

The bowels of a new-born infant usually move 
once or twice during the first day of life, the 
passage for the first two or three days consisting 
of a thick, sticky, odorless, black or greenish-black 
substance, called meconium. After this for the 
first six weeks there are as a rule two to four 
movements a day, golden yellow in color, show- 
ing a large proportion of water, having very little 
odor, and frequently containing small masses or 
curds. From this age to that of two years the 
bowels move normally but once to three times a 
day, the passage being of greater consistency and 
a little darker in color and having a rather more 
fetid odor. 

At least one free evacuation of the bowels is 
required in twenty-four hours. If the bowels 
have not moved by bedtime an enema of from 
four to eight ounces of soap and water, or a small 



188 THE CARE OF THE BABY 

glycerin suppository, should be given. The habit 
of having an evacuation at a certain time each day 
can be formed by placing a five or six months old 
child on a small chamber immediately after the 
morning bottle. The mother at this time may 
make some sound that the child will learn to 
associate with the act. 

More than four passages in twenty-four hours 
indicate that something is wrong with the diges- 
tive tract and requires attention. An acute intes- 
tinal disturbance may often be cut short if checked 
in time. One of the predisposing causes of sum- 
mer complaint is a chronic winter indigestion 
which has weakened the resistance of the 
intestines. 

The Baby's Food. 

There is only one food nature intended for a 
baby — its mother's milk. Cow's milk is intended 
primarily for a calf, whose digestive tract is 
entirely different from that of an infant. The 
full grown stomach can digest all sorts of food — 
the horse's oats, the cow's bran, the rabbit's let- 
tuce, the lion's animal flesh. There is scarcely an 
animal or vegetable that civilized man cannot eat 
and digest. A baby, however, is born with a 
stomach that is but partially developed, fitted 



THE CARE OF THE BABY 189 

only to digest human milk. That is why it is so 
difficult to bring up a baby on the bottle ; why so 
many bottle-fed babies die. 

Breast Feeding. 

Most mothers can nurse their babies. Espe- 
cially is this true when they have lived the 
hygienic life outlined in this book. When the 
milk is insufficient, measures can often be adopted 
to increase it or to supplement it with one or more 
bottles. 

Regularity in nursing affects favorably the baby 
and the breasts. It inculcates in the former a 
habit of desiring to be fed only at the regular 
feeding hour. The quality and quantity of the 
milk tends to remain uniform when the breasts 
are emptied at definite intervals. 

A baby may be put to the breast about eight 
hours after it is born, and then about four to six 
times in the twenty-four hours for the first two 
days of its life. This merely stimulates the secre- 
tion of milk and draws out the nipples into good 
shape for nursing. During this time the infant 
may be given every two hours one-half to one 
ounce of moderately hot water, containing a 
small pinch of sugar, or, if ravenously hungry, a 
very little modified cow's milk. 



190 THE CARE OF THE BABY 

Thereafter the baby should be nursed during 
the day every two hours for the first five weeks, 
every two hours and a half from the sixth to the 
twelfth week, every three hours from the third 
to the ninth month, and every three hours and a 
half from then until the twelfth month. At night 
one or two nursings are allowed during the first 
week, but after this for the first five months only 
one — at ten o'clock. After the fifth month the 
baby does not require to be nursed at night. It 
is wrong to feed the baby of tener than this ; but 
should it be asleep at its feeding time, which 
seldom occurs, it need not be disturbed but may 
be nursed when it awakens. 

Modifying the Breast Milk. 

The healthy normal baby does not want to 
nurse oftener than the above; it appears satisfied 
after nursing and during the first three months 
drops off to sleep immediately afterward ; it may 
awaken and seem restless as the feeding time 
approaches and usually cries if the nursing is 
delayed ; it gains not less than four ounces weekly. 
But if a baby cries some time before the nursing 
hour, if it appears restless and does not sleep, if 
it loses or remains stationary in weight or gains 
but three ounces a week or less, if it regurgitates 



THE CARE OF THE BABY 191 

or vomits or suffers from diarrhea or colic, there 
is probably some trouble with the food. The milk 
may be insufficient or excessive in its total quan- 
tity or in one of its ingredients. The mother 
should thereupon consult her physician, who will 
be able to suggest expedients for altering the 
quantity or quality of the milk. A woman can 
herself reduce the quantity of her milk by drink- 
ing less, and can increase it by drinking large 
quantities of water, thin cornmeal gruel, milk 
and cocoa — at least three quarts of fluid in twenty- 
four hours. Tea, coffee, ale, porter, and beer are 
not suitable for a nursing mother. The thin 
cornmeal gruel is easily made by adding one or 
two tablespoonfuls of yellow cornmeal to a quart 
of water or milk and boiling it for five hours in 
a double boiler with the lid on. It may be flavored 
by putting in ten or fifteen large raisins, a little 
salt and nutmeg. It is kept on ice and drunk 
from a bowl two or three times a day, preferably 
between meals and at bedtime. 

In habitual vomiting due to overfeeding it may 
be necessary to shorten the nursing period. When 
the baby has colic after nursing, in the absence of 
a physician, the mother may give it one to six 
tablespoonfuls of plain boiled water or barley- 
water immediately before each nursing. If the 



192 THE CARE OF THE BABY 

baby shows signs of hunger despite all efforts to 
increase the supply of milk it will usually be 
necessary to employ mixed feeding. A table- 
spoonful or more of barley-water or modified 
cow's milk may be given before or after nursing, 
especially in the case of recently born infants, or 
a bottle of modified cow's milk may be substi- 
tuted for the breast at one or more of the feeding 
periods. In all cases of indigestion and of con- 
tinued insufficient feeding a physician should be 
consulted. It may prove disastrous for the 
mother to experiment. 

The duration of nursing ought not to exceed 
fifteen minutes. After each feeding the baby's 
mouth should be washed out with a soft rag 
dipped in a solution of ten grains of boric acid in 
an ounce of water. 

Bottle Feeding. 

Occasionally a mother cannot nurse her baby, 
in which case resort must be had to a wet-nurse 
or to that poor substitute, the bottle. The point 
to be realized at the outset is the impossibility of 
imitating human milk. We now no longer even 
make such an attempt. Our object in artificial 
feeding is twofold : to give the baby a food it can 
digest and one that will nourish it. The usual 



THE CARE OF THE BABY 193 

method is to give cow's milk modified by the addi- 
tion of water, lime-water, barley-water, oatmeal- 
water, bicarbonate of soda, citrate of soda, pep- 
tonizing powder, patent infant food, or lactic acid 
germs, or by boiling. The milk in the first place 
must be clean and free from germs ; should germs 
be present they must be killed by pasteurization 
or sterilization. There is not the space to discuss 
fully in this chapter the vast subject of artificial 
infant feeding. It is best in every case to have 
a physician prescribe what the baby is to be given. 

The table on the following page gives the 
number of feedings, the amount to be given at 
one time, the intervals between bottles during the 
day and the hours of night feedings, arranged 
according to the baby's age. 

These are the average figures for a normal baby 
and may have to be varied in accordance with the 
physician's judgment to suit the individual case. 

Bottle and Nipple. 

It is necessary for bottles and nipples to be kept 
scrupulously clean ; else they will contaminate the 
milk. A cylindrical bottle, smooth inside and with- 
out angles or depressions, is best as it is easily 
cleansed. As soon as the baby has finished with 
it, the bottle must be taken away, emptied of any 

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THE CARE OF THE BABY 



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THE CARE OF THE BABY 195 

milk that may remain, rinsed well and placed in 
a strong solution of washing soda. Every eve- 
ning the bottles should be removed from this solu- 
tion and scrubbed inside with a bristle brush. 
Just before filling them it is important to rinse 
the bottles in clear water and place them in boiling 
water for ten minutes. 

At least two straight, conical rubber nipples 
are needed, preferably of black rubber, with holes 
of such a size that when the bottle is inverted the 
milk drops easily from it but does not run too fast 
or in a stream. The form of nipple which is 
attached to the bottle by a long rubber or glass 
tube must never be used, as it is impossible to 
keep the tube clean. 

Immediately after nursing, the nipple should be 
removed from the bottle, scrubbed thoroughly 
with a soft bristle brush at first outside and, after 
being inverted, inside as well. It should then be 
placed in a solution containing two teaspoonfuls 
of boric acid to a glass of water and kept there 
until used again. Once a day all the nipples 
should be boiled for five minutes in water con- 
taining a little table salt, the addition of which 
prevents the rubber from softening. Before being 
used the nipple is to be dipped for a moment in 
hot water. 



196 THE CARE OF THE BABY 

When the Bottle Disagrees. 

The symptoms of starvation and indigestion are 
the same in a bottle-fed baby as in an infant on 
the breast. When they occur it is necessary to 
consult a physician. The mother should bear in 
mind that delay often means death. 

It may happen when there is no physician avail- 
able that a mother has to put her baby on the 
bottle or has to make a change in the mixture 
she has been giving. In the presence of indiges- 
tion plain barley-water should be given for a few 
days. It may be made from the washed barley 
grains or from prepared barley flour. In the 
former instance two tablespoonfuls of washed 
pearl barley are put with a pint of cold filtered 
water in a saucepan and boiled for several hours 
slowly down to two-thirds and then strained. 
The other method is to beat up one or two heaping 
tablespoonfuls of barley flour with enough water 
to make a thin paste, which is placed in a double 
boiler, covered with a quart of cold water, stirred, 
boiled for at least fifteen minutes, and strained 
while hot through coarse muslin. In making up 
the first milk mixture an amount is prepared in 
accordance with the child's age as expressed in 
the table on page 194. Three-quarters of this 
should be barley-water and one-quarter of it clean, 



THE CARE OF THE BABY 197 

fresh raw milk. For every ounce of barley-water 
used half a level teaspoonful of sugar should be 
added — preferably milk-sugar. When the milk is 
positively known to be clean, fresh and pure, the 
baby's bottle can be placed in a cup of cold water 
and gradually heated to 95 or 100 degrees. If 
there is any question about the purity of the milk, 
however, it is best to bring the prepared milk to 
the boiling point or to actually boil it, then hold- 
ing the bottles under the spigot, to cool them 
rapidly with running water, and place them upon 
the ice. 

If this mixture agrees, the proportion after 
several days or a week can be made three-eighths 
milk and five-eighths sweetened barley-water, and 
later equal parts of each. This will usually be 
strong enough for a young baby. If it still 
appears hungry, however, the total quantity given 
in the bottle may be increased. The baby usually 
will take only what it needs and leave the rest. If 
the baby appears satisfied at the time but fails to 
gain sufficiently, does not sleep properly, and 
cries before the feeding time, the strength of the 
milk can be very gradually increased further. It 
is not safe for an uninstructed mother to give a 
mixture containing more than three-quarters milk 
to a baby under eight months of age. Should the 



198 THE CARE OF THE BABY 

first mixture suggested disagree, the proportion 
of milk should be reduced to one-eighth and the 
mixture boiled. If this disagrees the mother must 
experiment no further. 

The modifications just described are only for 
emergencies where no physician is available. 
They do not furnish the proper food for the indi- 
vidual child, but merely something that may agree 
with the baby and nourish it temporarily. 

The Feeding of Older Children. 

About the twelfth month the child is given 
oatmeal, barley or wheat jelly, made by cooking 
the cereal for three hours the day before it is 
eaten and straining it through a colander. A 
year old baby may be given chicken or mutton 
broth, stale bread and butter or zwieback and 
butter, and orange juice. From then up to the 
fifteenth month the following articles may be 
gradually added to the diet: rice in the broth, a 
soft boiled egg, apple sauce, baked apple, prune 
pulp, and one to three teaspoonfuls of scraped rare 
beef, mixed with an equal quantity of stale bread 
and moistened with beef juice. Between the fif- 
teenth and the eighteenth months the baby may 
have beef broth, a thoroughly baked white potato 
mixed with butter and salt, farina, cream of 



THE CARE OF THE BABY 199 

wheat, custard, cornstarch, plain rice pudding, 
junket and stewed prunes. From the eighteenth 
month to the second year the following additions 
are permissible: cornmeal and oatmeal porridge, 
hominy, mixed or scraped rare beef, the heart of 
a lamb chop finely cut, chicken, spinach, aspara- 
gus tips, squash, strained stewed tomatoes, stewed 
carrots, mashed cauliflower, soda, Graham or oat- 
meal biscuit. 

During its second year the baby is given four 
meals daily at regular hours, 7 and 11 a. m. and 
3 and 6 p. m., the orange juice being given usually 
at 9 a. m. Nothing is to be given between meals. 
From the different foods allowed the mother 
selects a suitable meal. Each new article must be 
carefully prepared and given at first in very small 
quantities, the child's ability to digest it being 
carefully observed. When one article is taken 
without difficulty another is tried, the increase in 
diet being gradually and cautiously made. 

Water. 

The baby gets thirsty as well as hungry. From 
the time of its birth it needs water, especially in 
the summer, and should be given cooled boiled 
water several times a day from a teaspoon, glass, 
cup, or nursing bottle. 



200 THE CARE OF THE BABY 

The Baby's Clothing. 

Wool is the best material for a baby's under- 
wear, the weight varying with the season. The 
clothes should be loose so as to allow sufficient 
freedom of motion. A circular band of knitted 
wool, made, as a rule, with shoulder straps and 
with a little tab in front to be fastened to the 
diaper, is the preferable form of abdominal 
binder, but one may use instead a strip of soft 
flannel twenty inches in length, cut bias, which is 
usually fastened to the shirt. The binder should 
extend from the hips to the lower ribs, but must 
not be too tight. 

Diapers are best made from soft light weight 
goods that absorb readily, such as bird's-eye cot- 
ton ; never from canton flannel or waterproof ma- 
terial. They must be changed as soon as soiled. 
They are then to be washed with pure soap, 
without soda, and thoroughly dried before being 
reapplied. 

A baby's socks are crocheted or knitted of silk 
or soft fine yarn and should reach fully half way 
to the knee. Moccasins of chamois, leather, kid 
or felt form excellent covering for the feet before 
the baby begins to stand or creep. It is important 
for the first shoes to be large, well shaped, and 
made of soft, pliable leather. 



THE CARE OF THE BABY 201 

At night the child is dressed in an entirely dif- 
ferent set of clothes. 

Bathing the Baby. 

The baby should be bathed daily at a regular 
time, such as ten o'clock in the morning, midway 
between two feedings. After its head has been 
wetted, it is placed in a tub of water of about 95 
degrees F. and washed for about five minutes 
with a soft wash rag and (except on the face) 
with pure soap. The baby then may immediately 
be given a brief rub with cool water. On being 
removed from the water the baby is enveloped in 
a towel and patted thoroughly dry, after which 
it is rubbed gently all over with the palm of the 
hand, powdered where two skin surfaces come in 
contact, and dressed. 

After each bowel movement the lower parts of 
the baby's body are sponged with warm water, 
but without soap, and carefully dried. When 
chafing occurs the parts should be cleansed very 
gently with starch-water, dried with a soft clean 
towel, and dusted with talcum powder. 

Sleep and Rest. 
A healthy, well-fed new-born infant sleeps 
practically all the time. For the first month a 



202 THE CARE OF THE BABY 

baby will sleep twenty-two hours out of every 
twenty-four, and during the second and third 
months twenty to twenty-two hours. If the baby 
does not sleep, something is wrong. In all prob- 
ability it has indigestion or is not getting enough 
to eat. A six months old baby should sleep from 
6 p. M to 6 a. M. without interruption, and should 
have a two-hour nap during the morning and 
another two-hour nap in the afternoon before 3 
o'clock. Until it is six years of age the child 
requires twelve hours of sleep. From the twelfth 
to the eighteenth or twenty-fourth month one 
hour is sufficient for the morning nap, which is 
given up after the second year. The afternoon 
rest may be shortened to an hour and a half at 
this age, being continued until the child is six 
years of age or even older, especially if he is 
inclined to be delicate. 

The properly trained baby never needs to be 
rocked or patted to sleep. It merely is laid in its 
crib and promptly drops off to sleep. This train- 
ing, however, should begin as soon as a baby is 
born. A new-born infant may be taken up to be 
nursed, to be washed and to be changed, but for 
nothing else. At all other times throughout its 
whole infancy it lies on its bed or blanket, except 
when it is being taken out. It must never be put 



THE CARE OF THE BABY 203 

to sleep in the arms. When good and quiet, how- 
ever, it may be held in the arms for a few minutes 
several times a day. But it must never be picked 
up and rocked merely because it cries, unless, of 
course, it is sick. Crying usually indicates 
hunger, discomfort due to a soiled diaper, pain 
due to colic, and spoiling. A child not properly 
trained from birth is usually accustomed to being 
picked up on crying and will probably require 
several days firm discipline before it realizes that 
crying will not cause it to be rocked; but the 
habit of going to sleep on being laid down is easily 
gained, provided the baby has sufficient food of 
proper character and is free from pain. 

Exercise and Fresh Air. 

The baby's best playground when it is young 
is a large clothes-basket, or a large, padded box, 
in which a thick blanket and a pillow have been 
placed, and a creeping pen or exercise pen when 
he begins to stand and makes attempts at walking. 
The floor is both dirty and draughty. 

The baby requires fresh air twenty-four hours 
out of every twenty-four. Its room therefore 
should be well ventilated. In the summer a baby 
may be taken out of doors when a month old or 
less. The outing is often postponed in the winter 



204 THE CARE OF THE BABY 

until the child is two or three months old. 
Extreme cold and wind are bad for the baby. 
During inclement weather the baby may be 
dressed as for going outdoors and all the win- 
dows on one side of the room may then be thrown 
wide open, the doors being closed. 

Digestive Disorders of Infancy. 

When the baby gets sick the proper thing to 
do is to send for the doctor. Nevertheless there 
are certain things a mother should know, so as 
to be able to obey the physician's orders intelli- 
gently and be of assistance to him. 

Digestive disturbances are the commonest dis- 
orders of infancy. They are usually due directly 
to faulty feeding. 

Want of sunlight and fresh air, insufficient 
clothing, filth, and above all hot weather, espe- 
cially when murky or humid, are indeed active 
factors in reducing the baby's resistive power and 
lowering its strength and vitality, so that its 
organs are easily disturbed and lose the power to 
fight germs. But what upsets the digestive system 
and introduces germs into it is bad and unsuitable 
food. 

The acute intestinal diseases that occur in the 
summer, known familiarly as summer complaint 



THE CARE OF THE BABY 205 

or summer diarrhea, which carry off so many 
babies each year, are therefore in a large meas- 
ure preventable. They are prevented first of all 
by feeding only milk that is absolutely clean or 
germ-free. The next most important preventive 
measure is to keep the baby and its digestive 
organs strong and resistant. By proper feeding 
and prompt correction of digestive disturbances at 
all times, the bowel is rendered better able to 
resist the germs when introduced during the hot 
weather. Proper hygiene — fresh air, proper 
bathing, proper clothing, all aid in making the 
child sturdy and strong. 

Above all the mother must realize that an 
attack of diarrhea or vomiting, or even a green 
undigested stool, occurring in an infant under 
eighteen months of age during hot weather, is a 
serious matter requiring prompt attention. When 
any of these occur she should stop the milk at 
once, administer a teaspoonful of castor oil mixed 
with a teaspoonful of aromatic syrup of rhubarb, 
give every two or three hours a bottle of barley- 
water containing about half a level teaspoonful 
of milk-sugar to the ounce, and send for the 
doctor. 

Under no circumstances must she give the child 
paregoric or any of the patent medicines for 



206 THE CARE OF THE BABY \ 

summer complaint or diarrhea, all of which con- 
tain opium, a drug poisonous to babies even in 
minute doses. 

Colic. 

When a baby is subject to colic it is the prov- 
ince of the family physician to investigate the 
cause. If colic in a nursing baby is due to con- 
stipation in the mother, the remedy is plain ; when 
due to too much or too strong milk or to too fre- 
quent nursings, it can often be relieved by feeding 
less and pumping out what milk is left in the 
breasts, by giving plain water or barley-water 
before each nursing, or by increasing the interval 
between nursings. In a bottle-fed baby the phy- 
sician must adapt the food to the baby's digestive 
capacity. 

For the attack itself a mother may give an 
enema at no degrees F. of soapsuds or of eight 
ounces of water containing a teaspoonful of salt, 
she may administer every half hour or hour 
twenty drops to a teaspoonful of soda mint mixed 
with an equal quantity of hot water, and she may 
place over the abdomen a spice plaster or other 
hot application. Soothing syrups, baby cures, 
laudanum and paregoric must all be avoided. 
They may kill the child. 



THE CARE OF THE BABY 207 

Contagious Diseases. 
The contagious diseases that occur most fre- 
quently in children are tonsilitis, influenza or grip, 
measles, rubella or German measles, chicken pox, 
mumps, whooping cough, diphtheria and mem- 
branous croup, scarlet fever, acute conjunctivitis 
or pink eye, scabies or the itch, and tuberculosis 
or consumption. Each disease may appear in a 
very severe or in a very mild form. The latter is 
the more dangerous to others because seldom 
recognized. When a child has a severe attack of 
measles, diphtheria or scarlet fever, the mother 
usually realizes that something serious is the 
matter and sends for the physician, who diag- 
noses the case and orders strict isolation, instruct- 
ing the mother how to disinfect everything that 
comes out of the sick room. But sometimes the 
child with measles is scarcely sick at all and 
merely has a very slight rash, which the mother 
calls a stomach rash. Diphtheria often appears in 
the form of a mild sore throat, that does not 
hinder the child from playing about as usual. A 
little vomiting and a slight redness of the skin 
lasting for a day or so may be the only symptoms 
of scarlet fever until the skin begins to peel a 
couple of weeks later. In all cases of illness 
therefore it is best to send at once for the doctor. 



208 THE CARE OF THE BABY 

The mother would do well to remember that 
a child may be able to give a disease to others for 
some time after it appears well. This is particu- 
larly true in measles, scarlet fever, diphtheria 
and mumps. Some diseases, moreover, such as 
measles and whooping cough, are contagious 
before their most characteristic symptoms appear. 

As to the method of treatment and nursing, the 
character and duration of the isolation, and above 
all the diagnosis of these diseases, one must be 
guided absolutely by the attending physician. 



CHAPTER XXII. 



THE CAUSES OF WOMEN'S DISEASES AND 
THEIR REMOVAL. 

Mismanagement During Childbirth. Imprudence after 
Labor. Artificial Termination of Pregnancy. Unhy- 
gienic Marital Relations. Personal Purity a Factor. 
Chronic Constipation. The Majority of Women's 
Diseases Preventable. 

Much of the sickness, disability, pain and dis- 
comfort from which women suffer can be avoided, 
being for the most part due to ignorance and neg- 
lect. Among the more frequent causes of disor- 
ders peculiar to women are imprudence and neg- 
lect during and after childbirth, artificial termi- 
nation of pregnancy, unhygienic marital relations, 
infection from a diseased husband, chronic con- 
stipation, and disregard of the laws of hygiene. 
Prevention, therefore, lies to a great extent in a 
woman's own hands. 

Mismanagement During Childbirth." 
The chronic invalidism common among mar- 
ried women results in many cases from bad man- 
X4 (209) 



210 THE CAUSES OF WOMEN'S DISEASES 

agement, imprudence, carelessness, or neglect, 
either at the time of labor or during the weeks 
immediately following it. Most frequently it is 
due to lacerations received during the passage of 
the child, but which have never been repaired, and 
sometimes not even recognized. When a midwife 
has been employed instead of a physician this mis- 
management is more liable to occur. Midwives, 
as a rule, are unable to recognize any but the 
most conspicuous injuries, and in many in- 
stances they are utterly incompetent to prevent 
lacerations. 

An unrepaired laceration or tear that has oc- 
curred during labor is a common cause of a back- 
ward displacement of the womb, and especially 
of falling of the womb. Prompt repair of a 
laceration occurring during childbirth may some- 
times prevent cancer, which frequently begins at 
the site of an old tear of the neck of the womb 
which has never received attention. 

Another cause of disease having its origin in 
childbirth is the absence of surgical cleanliness 
on the part of the nurse in connection with every- 
thing that pertains to her patient. The preven- 
tion of an acute inflammation of the womb, for 
instance, lies in the observance of surgical clean- 
liness by physician, nurse, and patient both during 



THE CAUSES OF WOMEN'S DISEASES 211 

and after a labor or miscarriage. If everything — 
hand, instrument, dressing — that touches the 
private parts is surgically clean, and if the direc- 
tions given in Chapters XVII, XIX and XX are 
strictly observed, such a complication will be pre- 
vented. Observance of surgical cleanliness dur- 
ing and after a labor or miscarriage will also pre- 
vent acute inflammation of the Fallopian tubes, 
which is a septic infection or poisoning usually 
due to an extension from an acutely inflamed 
womb. This condition consequently may occur 
after a criminal abortion, miscarriage or labor in 
which infection has occurred. It frequently leads 
to peritonitis or blood poisoning, which may go 
on to a fatal termination, or may require a dan- 
gerous operation in order to save the woman. 
This is one of the reasons why any one who sub- 
mits to a criminal abortion runs the risk of losing 
her life. 

Imprudence After Labor. 

Imprudence during the puerperium is also a 
frequent cause of women's diseases. After a 
labor at term the womb is six weeks in returning 
to the normal. In order that this process may 
proceed uninterruptedly to a perfect conclusion, 
rest is essential. One of the ill effects, therefore, 



212 THE CAUSES OF WOMEN'S DISEASES 

of a woman's getting up too soon after childbirth 
and resuming her household duties, is failure of 
the womb to diminish in size and to become re- 
stored to its original condition ; instead it remains 
enlarged and congested, frequently undergoing a 
chronic inflammation. At the same time the mem- 
brane lining the uterus is rendered more liable 
to disease and becomes very easily affected. An- 
other danger, when a woman rises too soon after 
confinement, is that the large and heavy womb is 
likely to be displaced, especially as the ligaments 
supporting it have been weakened and stretched. 
If the abdominal compress is misapplied after 
labor — placed over the womb instead of above it 
— it may press this organ backward and thus 
cause a backward displacement. 

Artificial Termination of Pregnancy. 

Seldom is pregnancy terminated by artificial 
means without a long train of diseases following. 
Frequently the criminal operation ends in death. 
Chronic invalidism always results. Moreover, in 
such cases, to the risks of an ordinary miscarriage 
is always added the danger of blood poisoning. 

Unhygienic Marital Relations. 
A woman's general health suffers and her gen- 
erative organs become diseased when the normal 



THE CAUSES OF WOMEN'S DISEASES 213 

marital relations are disturbed. Excess not only 
exhausts the nervous system and leads to a con- 
dition known as neurasthenia, but it also causes 
chronic congestion of the organs, with resultant 
abnormalities and disease. The various methods 
adopted to prevent conception are all injurious; 
their traces can be seen in the nervous breakdowns 
and local diseases that inevitably follow their use. 

Personal Purity a Factor. 

Personal purity is the chief protection from 
pus tubes and other chronic and acute conditions 
having their origin in gonorrhea. Many inno- 
cent women, however, are made to suffer and 
even die for the faults of others. When a young 
man sows his wild oats, it is usually his future 
wife who must reap them. For her own protec- 
tion, therefore, a girl should only marry one 
known to be free from venereal disease. 

Chronic Constipation. 

It is a well-known fact that the great majority 
of women are habitually constipated. Some may 
not have a passage of the bowels for weeks at a 
time. The large, hard fecal masses present in the 
rectum by pressing on the veins coming from the 
generative organs produce piles, and, by thus in- 



214 THE CAUSES OF WOMEN'S DISEASES 

terfering with the circulation give rise to conges- 
tion of the pelvic organs, and the diseases usually 
following it. At the same time the poisons in the 
fecal discharges, that should be expelled from the 
intestines, are slowly absorbed back into the 
blood, causing many and varied symptoms and 
often preventing proper general development. 

The regulation of the bowels is largely a mat- 
ter of habit. Medicines are of little use as a cure, 
although they may act for a short time. Drugs 
should never be taken regularly, as they lose their 
effectiveness with continued use. It is much bet- 
ter for a woman to accustom herself to habits of 
regularity. A sedentary life without exercise is 
the most common cause of constipation. 

This condition may often be corrected by exer- 
cise, as a substitute for which massage of the 
abdomen may be employed. It is well to drink 
plenty of water, hot or cold, a glassful on getting 
up in the morning and another at bedtime being 
particularly useful. 

Attention to diet may itself cure constipation, 
especially the eating of vegetables, fruits and 
coarse breads. The vegetables that are most laxa- 
tive are tomatoes, spinach, lettuce, asparagus, 
Spanish onions, salsify, cabbage and celery. The 
coarse cereals, such as oatmeal, cornmeal and 



THE CAUSES OF WOMEN'S DISEASES 215 

wheaten grits, and bread made of coarse flour, 
such as Graham, rye, corn, oats and whole wheat 
meal, also help to relieve constipation, as well as 
to prevent it. The addition of bran to ordinary 
flour makes an especially efficacious bread. Nearly 
all fruits have a laxative influence, which is most 
marked when they are taken alone. Honey and 
molasses are better than any medicine. It is well 
to take fruit, honey or preserves with each meal, 
or at least with breakfast. 

Regularity in habits is probably the most im- 
portant factor in both preventing and curing this 
condition. 

The Majority of Women's Diseases Preventable. 

The enumeration of the causes that give rise 
to the diseases from which women suffer brings 
out the important fact that the majority of them 
are preventable. It shows how false is the idea 
so prevalent among women that they have an in- 
herent tendency to disease of the generative or- 
gans, and are to be considered lucky if they 
escape. The statement may safely be made that 
the number of diseases that are unavoidable is 
small compared with that large number of diseases 
for which the woman is herself directly responsi- 
ble. Carelessness and indiscretion, the result usu- 



216 THE CAUSES OF WOMEN'S DISEASES 

ally of ignorance, cause the greater amount of 
women's suffering. It is to be hoped that, with 
a knowledge of the causes of the diseases peculiar 
to her sex, a woman will be better able to avoid 
them. 



CHAPTER XXIII. 



CLOTHING AND POSTURE IN RELATION 
TO DISEASE. 

Underwear. Shoes. Harmfulness of the Ordinary Corset. 
The Proper Shape for a Corset. Supporting the Skirts. 
Incorrect Posture. How to Maintain a Proper Position. 
To Sit and Walk Properly. 

Probably the most important factor in preserv- 
ing health and preventing disease is attention to 
personal hygiene, by which is meant proper air, 
eating, drinking, clothing, bathing and exercise 
and sufficient rest. 

Underwear. 

Improper clothing is responsible for many dis- 
eased conditions, the body frequently being insuf- 
ficiently protected from cold. Undergarments 
are often made of unsuitable material and so fash- 
ioned that they leave the neck, chest, arms or 
lower limbs unprotected. Open work stockings, 
thin slippers, and dresses cut low, leaving the 
neck and shoulders bare, are by no means uncom- 
(217) 



218 CLOTHING AND POSTURE 

mon. When a person thus insufficiently clad is 
exposed to cold, or to a sudden change of tem- 
perature, as in leaving a heated ballroom far the 
cool air of a hall or veranda, or in stepping into 
the yard from a hot kitchen, the skin becomes 
chilled and the person "catches cold." In other 
words, the blood-vessels in the skin contract, driv- 
ing the blood into the internal organs, and thereby 
causing them to become congested. The effects 
of such exposure are much more serious when it 
occurs during menstruation, as at this time the 
pelvic organs already contain an excessive amount 
of blood. 

The primary object of clothing is to protect the 
body from changes in temperature and from mois- 
ture. The various materials are selected in ac- 
cordance with their power of conducting heat and 
their capacity for absorbing moisture. 

The best material for underwear is flannel or 
wool, as both are poor conductors of heat and 
good absorbents of moisture. If of a finely 
combed texture they will not irritate the skin. 
Silk is as good, but more expensive. When cot- 
ton or linen is woven loosely, with large meshes, 
it preserves the body heat owing to the poor con- 
ductivity of the air contained in the meshes. 

Stockings are best made of wool, or at least 






CLOTHING AND POSTURE 219 

with woolen feet, in order that they may rapidly 
absorb the moisture from the feet. They should 
not fit too snugly, but should be large enough to 
allow the feet to expand when walking. Stock- 
ings deform the feet least when made in rights 
and lefts with straight inner edges, or, better 
still, with a separate compartment for the great 
toe. 

Shoes. 

The only shoe that does not injure the foot is 
one with a flat sole, a straight inner edge, a gentle 
curve on the outer side, and a broad and low 
heel. When the heels are high, they weaken the 
arch of the foot by causing a wasting of the mus- 
cles and ligaments. A properly fitting shoe is 
three-fourths of an inch longer than the foot. 
The latter works forward in walking and unless 
it is given sufficient room will develop corns and 
bunions. If too loose, however, the shoe allows 
the heel to rub. Shoes made of plain leather per- 
mit proper ventilation of the feet, but patent 
leather shoes are impermeable to air and do not 
allow sufficient evaporation of the perspiration of 
the feet; consequently the latter should not be 
worn continuously. It would be even better not 
to wear them at all. As rubber also will not per- 



220 CLOTHING AND POSTURE 

mit air to pass through it, boots and shoes of 
this material should not be worn longer than 
necessary. 

The Harmfulness of the Ordinary Corset. 

The constriction of the modern female dress, 
as typified by the corset, does harm in many 
ways; it interferes with the proper functions of 
the organs in the chest, abdomen and pelvis. The 
restriction it causes to the proper expansion of 
the lungs may in time lead to consumption. It 
frequently produces slight displacements of the 
heart, which in consequence often becomes very 
irritable. 

Tight lacing and the suspension of heavy cloth- 
ing from the waist affect the breathing in still 
another way by impairing the abdominal respira- 
tion. At the same time the abdominal walls are 
weakened and the abdominal organs are pressed 
down by this injurious force. The stomach be- 
comes stretched and its digestive powers are in- 
terfered with. It, as well as other of the abdomi- 
nal organs, may be dragged out of place. A 
chronic dyspepsia results from these changes, in- 
volving both the stomach and the intestines, and 
being associated with chronic constipation and 
distension of the bowels. The wearing of tight 



CLOTHING AND POSTURE 221 

corsets has even led in some cases to the occur- 
rence of appendicitis. 

Compression exerts no less serious an effect on 
the pelvic organs. It may cause the womb to 
be displaced backward and downward, and, 
through interference with its circulation, to be- 
come chronically congested and later become the 
seat of other and more serious disorders. The 
ovaries and Fallopian tubes are likewise crowded 
out of their normal position by tight lacing. Dur- 
ing pregnancy, constriction of the abdomen may 
produce a miscarriage or may affect the shape 
and position of the child; it always renders the 
occurrence of varicose veins more likely during 
this period, as also does the wearing of circular 
garters. 

Many styles of corsets throw the body into an 
unnatural position, imposing a strain on the mus- 
cles and ligaments of the back and hips with re- 
sulting weakness and backache. Much of the 
so-called "kidney trouble, ,, "womb trouble," 
lumbago and sciatica, from which women be- 
lieve they suffer, is in reality a strain caused by 
this faulty position. As demonstrated by Drs. 
Reynolds and Lovett, of Boston, the corsets that 
almost always produce backache are those that 
are long behind (especially at the top) and short 



222 CLOTHING AND POSTURE 

in front (especially at the bottom) and curve in 
markedly at the waist in front. They exert their 
greatest pressure at the waist, and at top and 
bottom press only against the wearer's back. 
These throw the hips back and destroy the center 
of gravity. 

The Proper Shape for a Corset. 

The corset that does least harm is one that is 
short behind (especially at the top) and relatively 
long in front (especially at the bottom). It 
should fit the wearer tightly around the hips and 
decrease regularly in pressure to its upper edge 
where it should be very loose (especially behind). 
The proper corset is curved in considerably at the 
waist line at the back and sides, but shows no 
waist curve in front. Three other points are 
important. It is essential that the more important 
seams run diagonally forward and downward in 
order to secure the proper lines of strain in the 
cloth. The bones which serve to keep the corset 
from wrinkling should run in such directions as 
not to interfere with these strains. 

Before putting on the corset all the lacing must 
be widely loosened. The corset is then settled 
into place as low as it can be worn, and clasped. 
Passing her hand inside the corset the woman 



CLOTHING AND POSTURE 223 



then lifts her abdomen into it, settling the front 
of the corset as low as possible. The middle lac- 
ing should be pulled comfortably snug, the lowest 
lacing being then made as tight as can be borne. 
The upper lacing is left as loose as is comfortable. 

Supporting the Skirts. 
It is injurious to support heavy skirts from 
the waist or hips. They should instead be sus- 
pended from the shoulders by means of suspend- 
ers or a waist. If the pressure, however, be ex- 
erted on the outer portion of the shoulder, espe- 
cially in growing girls, it produces round shoul- 
ders. This deformity is particularly likely to 
occur when the girl is weak or poorly developed, 
and may persist throughout life. A waist has 
been devised by Dr. Goldthwait, of Boston, in 
which the weight of the clothes is applied to the 
rigid or inner part of the shoulder at the base 
of the neck, which can bear any amount without 
lowering of the shoulder. If this waist were 
worn from early childhood up, much of the round 
shoulder deformity seen in growing girls would 
be averted. 

Incorrect Posture. 

Much suffering results from incorrect positions 
of sitting and standing. When the spine is not 



224 CLOTHING AND POSTURE 

held erect, with its double curve preserved, undue 
strain falls on the muscles and ligaments of the 
back, especially the lower portion, with resultant 
strain and disability. At the same time the ab- 
dominal muscles become relaxed, causing loss of 
support to the organs of digestion, which fre- 
quently drop, with the development of indiges- 
tion, nervousness and constipation. 

How to Maintain a Proper Position. 

In standing, a woman should place her feet 
almost parallel, the heels being one to six inches 
apart, as may be easiest, the toes turning outward 
a little, as is most natural and comfortable for 
the individual, and let her arms hang easily by 
her sides. When the chest is drawn up to a high 
position, all the other parts of the body naturally 
fall into their proper relations with it. The 
weight of the body should be thrown forward on 
the ball of the foot and toes, rather than on the 
heel. This position sometimes is assumed more 
easily if one endeavors to pull up the crown of 
the head, or to keep the neck pressed back against 
the collar. 

The ease and balance of this position may be 
tested by rising on the toes as far as possible, 
maintaining the position for a moment, and com- 



CLOTHING AND POSTURE 225 

ing down gently until the heels touch the floor. 
When this can be done without losing the balance, 
the proper position has been assumed; but if the 
person has to take a step forward or backward 
to recover her equilibrium, the center of gravity 
is misplaced and the position must be resumed 
until, after a few attempts, the proper position 
is found and kept. In this position the shoulders, 
hips and ankles will be in a straight line. The 
correct carriage may be tested by passing the 
hand over the back; if the ends of the shoulder- 
blades can be felt, the carriage is correct. 

To Sit and Walk Properly. 

A girl should sit on the whole seat of a chair, 
not just on the edge. When she is seated back 
on a properly fitting chair, the seat supports about 
three-fourths of her thigh, while her feet rest 
easily on the floor, or on a footstool, if the chair 
is too high. The erect position is maintained by 
drawing up the crown of the head. 

Harm is done by lounging in a chair or allow- 
ing one's self to flop. If too fatigued to sit 
straight a woman should lie dow r n until she is 
rested. It is injurious to sit in a chair resting 
on one foot, or leaning the head upon the hand, 
or bending the head forward or stooping at the 

15 



226 CLOTHING AND POSTURE 

shoulders. One should always lean forward from 
the hips and not from the waist. Unless proper 
postures are maintained, no amount of exercise 
can overcome the deformities that will be 
produced. 

In walking, the correct standing position is 
first assumed, with the chin up, the chest forward, 
and the abdomen in. The shoulders will then fall 
into their proper position and not have to be 
pushed back. In walking up stairs a girl should 
hold herself erect, keeping the back, neck and 
head in a straight line. She should not bend 
forward in passing from step to step, nor run up 
stairs, but should place each foot flat on the step, 
taking deep breaths as she slowly ascends. She 
may walk down stairs very gracefully by not 
springing upon the steps, but by bending the 
knees and dropping the weight from step to step 
with as little motion as possible. 



CHAPTER XXIV. 



THE ROLE OF AIR, FOOD, BATHING, EXER- 
CISE, REST AND RECREATION IN MAIN- 
TAINING ONE'S HEALTH. 

Fresh Air. Food. [The Cleansing Bath. The Cold, 
Hygienic, or Hardening Bath. Exercise. The Neces- 
sity for Rest and Recreation. 

Like any other delicate mechanism, the human 
body requires intelligent care if it is to endure, 
remain in good condition, and retain its full effi- 
ciency. But unlike the inanimate machine, whose 
parts are only replaced at long intervals when 
worn out, the tissues of the body are continually 
being used up and renewed. Food and air fur- 
nish the material for replenishing them. Repair 
goes on chiefly during rest and sleep. It is mainly 
during work and exercise that the tissues are 
used up. These and other subjects naturally 
demand consideration if health is to be preserved. 

Fresh 'Air. 
The oxygen needed to keep the tissues in good 
condition and able to resist disease is found only 
(227) 



228 MAINTAINING ONE'S HEALTH 

in pure air. An atmosphere laden with the poi- 
sons exhaled from the lungs is not fit to breathe. 
Proper ventilation consists in allowing the foul 
air to escape and the fresh air to enter an apart- 
ment continually. This is necessary in living 
rooms, but especially so in the bedroom. One 
should sleep with the windows open, top and 
bottom, as far as they will go. Only pure air 
then will enter the lungs. The bed clothes protect 
the body from the cold just as effectively as does 
the clothing when one is out of doors. In neither 
instance is cold air on the face unpleasant or 
harmful. 

It is just as important to breathe fresh air 
at one's work as at home. One should insist, 
therefore, on proper ventilation in office, factory 
and store. 

In cold weather direct currents of air are ob- 
jectionable in living rooms. Draughts can al- 
ways be avoided by placing under the lower 
window sash a board from four to six inches 
wide, or by utilizing some other simple expedient. 

Food. 

Improper food has its share in causing disease. 
To keep the body strong and well, so as to be 
able to combat disease, good nourishing food is 



MAINTAINING ONE'S HEALTH 229 

required. Many painful conditions of the genera- 
tive organs, moreover, are due to an impover- 
ished state of the blood caused by malnutrition. 
It is important, therefore, for every woman to eat 
a sufficient amount of good food properly pre- 
pared. It has been said that the American woman 
in the rural districts is half starved, not because 
she does not get enough to eat, but because she 
does not eat the kind of food that makes rich 
blood and tends to build up the tissues of the body. 
The farmer's wife, for instance, instead of being 
stout and of good color, is often pale and thin. 
This is in part due to the too frequent use of the 
frying pan, to the eating of salt fish and meats 
instead of fresh foods, to the drinking of coffee 
and tea instead of milk and cocoa, and, above all, 
to the constant presence on the table of pies and 
hot bread. In the large cities, on the other hand, 
many women eat too much, and in consequence 
develop dyspepsia, constipation, and allied dis- 
orders, the late eating and drinking among the 
fashionable people being productive of much 
chronic trouble. 

The necessary constituents for a perfect food 
are provided in the most digestible form by a 
mixed diet, which contains both vegetable and 
animal food, the best ratio being one part of raw 



230 MAINTAINING ONE'S HEALTH 

animal food to three parts of raw vegetable food. 
A person doing hard muscular work, however, re- 
quires a larger amount of vegetable food than 
one who leads a sedentary life. 

It is important to allow sufficient time for meals. 
The hasty midday lunch of shop girls is one of 
the most frequent causes of indigestion. There 
should be an intermission of at least one hour 
in the middle of the day, part of which should 
be devoted, both before and after eating, to rest 
or pleasant conversation. If one has but little 
time for the midday meal it is better to take a 
very light lunch, or even only a plate of soup and 
a glass of milk with a few crackers, than to gulp 
down a more substantial dinner. On the other 
hand, the habit of going without the midday 
meal is most pernicious. 

The Warm Cleansing Bath. 

The outer skin is constantly being shed in the 
form of dead, dry scales, while the oil glands 
deposit grease on its surface. Both the scales and 
the grease tend to collect on the skin and, with 
or without dirt, to form a coating which stops 
up the mouths of the tubes from the sweat glands, 
the "pores/' thus preventing the proper functions 
of these glands. To remove this accumulation, 



MAINTAINING ONE'S HEALTH 231 

which may be so fine as to be almost unnoticeable, 
a cleansing bath is necessary. 

Warm and temperate baths are best suited to 
secure cleanliness. As water alone cannot dis- 
solve the grease upon the skin, the use of a pure 
soap is required. Warm baths should not be 
taken within two hours after a meal. As heat 
relaxes the blood-vessels in the skin, a person is 
liable to take cold after a warm bath unless she 
goes immediately to bed, thus preventing ex- 
posure, or else takes a cold sponge or shower, 
followed by brisk rubbing, which restores tone 
to the blood-vessels, thus causing the skin to 
return to its normal condition. 

The Cold, Hygienic, or Hardening Bath. 

A cold bath followed by brisk rubbing stimu- 
lates the whole system and by accustoming the 
blood-vessels of the skin to variations of tempera- 
ture, hardens the body against catching cold. 

When the cold water comes in contact with the 
skin, the blood-vessels of the skin contract. Later, 
the time depending upon the reactive ability of the 
individual, these same blood-vessels dilate and 
thus allow the circulation in the skin of a greater 
amount of blood than before. This is called the 
reaction, which consists in the restoration to the 



232 MAINTAINING ONE'S HEALTH 

skin of the heat that has been abstracted. It is 
the most important element in all cold applica- 
tions. The benefit of the cold bath comes from 
this reaction, or glow, or feeling of warmth, that 
follows it. 

A person not accustomed to cold bathing 
usually requires a brisk rubbing for several min- 
utes after the bath to produce this reaction. As 
one becomes accustomed to the cold bath, how- 
ever, the reaction occurs more and more quickly, 
requiring less and less rubbing, until finally it 
may occur as soon as the cold water strikes the 
body. The reaction is promoted or increased by 
supplying heat to the body before the bath by 
means of a hot tub or sponge bath or a brisk rub, 
by active exercise during or after the bath, or by 
the administration of stimulants either before or 
after the bath. 

The commonest forms of the cold bath are the 
full tub bath, also known as the plunge or dip, 
the shower bath and the sponge bath. Everybody 
is able to take a cold bath, but everyone cannot 
at once, without having been accustomed to it, 
take the same kind of a cold bath. Yet all, except 
the very old, can be trained so as to be able to 
take any form of the cold bath with benefit and 
without discomfort. 






MAINTAINING ONE'S HEALTH 233 

The best time for taking a cold bath is imme- 
diately upon rising, while one is still warm from 
the bed. Before the cold bath is taken, the face 
and head should be wet with cold water to pre- 
vent the blood rushing to the head. After every 
kind of a cold bath it is essential that a complete 
reaction take place, in other words, that the per- 
son become red and warm. If a woman feels 
chilly after the bath and does not become warm 
after brisk rubbing, she should go to bed until 
she has reacted, after which she may get dressed. 
There is no danger of taking cold after the bath 
if reaction occurs, as the warm blood coursing 
through the dilated vessels in the skin acts as a 
protection to the body. One can go out into the 
open air immediately after a cold bath that has 
been followed by a good reaction. 

Exercise. 

The majority of women fail to realize how es- 
sential to health is daily exercise in the open air 
and they neglect this important means of keeping 
the muscles and internal organs in a normal con- 
dition. In the cities many of the girls and 
younger women indulge in various sports, such 
as golf, tennis, bowling, rowing, and so forth, 
but others, especially the older women, remain 



234 MAINTAINING ONE'S HEALTH 

indoors, confining themselves to the close atmos- 
phere of the house, seldom engaging in any work 
or play involving the least exertion. In the 
country districts women commonly take even less 
exercise than they do in the city; the farmer's 
wife and daughter spend most of their time in 
stuffy and overheated rooms. Those who neglect 
to take sufficient exercise often suffer in conse- 
quence from obesity, loss of appetite, indigestion, 
chronic constipation, ill-defined pains and men- 
strual irregularities. 

On the other hand, if the exercise be excessive, 
or be indulged in at the wrong time, it may itself 
lead to conditions of ill health. During the men- 
strual period a woman should avoid all exercise 
and consequently should not indulge in violent 
games, in dancing or in surf bathing. Violent 
exertion of any kind is always dangerous to a 
pregnant woman. 

Even housework may be utilized in developing 
the figure, if attention be paid to the positions 
assumed. When sitting at any kind of work, 
such as sewing or paring apples, a woman should 
avoid the temptation to stoop. It is so easy to 
curve the back and shoulders and on getting up 
forget to straighten out again. After several 
years of such bad habits the shoulders will be 






MAINTAINING ONE'S HEALTH 235 

round, the head protruding, the neck thin and 
the chest flat and narrow. It is important to 
maintain the proper erect posture when standing 
at one's work. Kneading bread, with the shoul- 
ders thrown back, will develop splendid arm mus- 
cles, provided the moulding-board be at the proper 
height. One of the best physical exercises and 
one that gives the shoulders splendid development 
is the old-fashioned scrubbing on hands and 
knees. One must remember, however, to keep the 
back straight, the chest forward and the abdomen 
drawn in. It is well to develop both sides equally 
by first using one hand and then the other. Like- 
wise when sweeping, the broom should be 
changed from side to side to prevent one-sided 
development. The same principle may be applied 
to ironing, it being most important to have the 
ironing-board at a comfortable height. 

One should be properly dressed for housework. 
The best costume consists of a loose flannel 
blouse, with the collar loose and low, and a short 
skirt made like a gymnasium suit. Corsets and 
high-heeled slippers are entirely out of place. 

fhe Necessity for Rest and Recreation. 

Many nervous disorders are due largely to 
women not taking sufficient rest. Young girls 



236 MAINTAINING ONE'S HEALTH 

frequently go out night after night during a 
whole winter's gay season, coming home from a 
dance often at four or five o'clock in the morning. 
With the using up of the nervous energy which 
she needs for resisting disease, a society woman 
frequently becomes the prey of various disorders. 
Nor is the society woman the only offender. 
Many working girls, after standing before a loom 
or behind a counter from early morning till sun- 
down, will go out again after supper and will 
not return until late at night. The mother of a 
large family after a hard day's work often sits up 
until midnight sewing. It is no wonder, there- 
fore, that with thi i waste of her vital force, a 
woman loses her inborn vitality to combat disease 
and soon succumbs to one of the many diseases 
peculiar to her sex. 

It is important for a woman to be able to relax 
at intervals. When the eyes are steadily engaged 
in near work they should be rested every half 
hour or every hour during the day by being made 
to look off into the distance for a moment or two. 
It is well to relax the mind in the same way by 
now and then ceasing thoughts of one's work 
and for a moment recalling something pleasant 
that has been seen, read or noticed. 

An overworked mind often finds rest in pleas- 



MAINTAINING ONE'S HEALTH 237 

ant conversation, in cheerful games which are not 
too intricate, in seeing plays and moving pictures 
and hearing operas and concerts, in reading pleas- 
ant books and in the cultivation of fads. A hobby, 
such as the collection of stamps, rare prints, old 
coins, old china, old furniture, and the like, fur- 
nishes an agreeable diversion by taking one's 
mind off the daily worries. On the other hand, 
recreation involving some mental labor may be 
of advantage to a person whose work is physical 
and whose mind is little exercised. For her, 
chess-playing is an interesting diversion and even 
Sunday-school teaching may prove beneficial. 
Such forms of recreation, however, are injurious 
to one whose mind is constantly on a strain, such 
as a public school teacher. 

In the middle of the day a rest from work of 
at least one hour is essential, so that time will be 
allowed for half an hour's freedom from work 
after luncheon. This time is best spent by those 
who have been standing all morning in reclining, 
and by those who have been sitting in walking in 
the open air. A person employed in manual labor 
may spend this time in reading, but a brain 
worker will be more benefited by mental rest. 

At the end of each week a woman should rest 
for at least twenty-four hours. Once a year, too, 



238 MAINTAINING ONE'S HEALTH 

she requires a complete rest of not less than two 
weeks, taken preferably in the summer. This va- 
cation restores the weakened muscles and diges- 
tive organs to their normal healthy condition 
after the close strain of the winter's work. 

Eight hours of continuous sleep each day is 
usually sufficient for the average adult. Children 
require much more, while aged persons do not 
need quite so much. Persons who have to rise 
early during the week would do well to lie in bed 
longer on the day of rest, 



CHAPTER XXV. 



THE TEMPORARY RELIEF OF SYMPTOMS. 

Emergencies. Temporary Treatment of Pain. Headache. 
Backache. Abdominal Pain. A White Vaginal Dis- 
charge. A Yellow Discharge. A Bloody Discharge. 
Danger in Patent Medicines. 

It is in preventing disease that a woman can 
utilize what knowledge of hygiene she possesses. 
When once the disease has occurred, the advice of 
a competent physician must always be sought. 
On the first evidence of anything being wrong, 
therefore, a woman should consult a reliable phy- 
sician. No one but a trained physician has the 
ability to recognize what condition is present, and 
none other can advise the appropriate treatment. 
An enumeration of the symptoms that arise from 
disease of the generative organs would merely 
serve to make a woman introspective and appre- 
hensive, without rendering her capable of prop- 
erly interpreting any symptoms she might notice 
in herself. 

But it is a great mistake for a woman to be 

(239) 



240 TEMPORARY RELIEF OF SYMPTOMS 

continually on the lookout for symptoms; she 
should not always be examining herself to ascer- 
tain if she is normal. Such a practice produces 
a nervous disorder, a condition bordering on in- 
sanity, known as hypochondriasis or morbid in- 
trospection. As any description of symptoms has 
a tendency to make hypochondriacs of its readers, 
such has been avoided in this book as much as 
possible. Only in the case of danger signals, 
when the life of a woman depends upon her early 
recognition of the first warnings, have the symp- 
toms been fully described. 

Emergencies. 

It is not always possible, especially in the coun- 
try, to procure a doctor at a moment's notice. In 
such a case a woman may have to suffer for hours, 
unless she is able to obtain temporary relief. For 
these emergencies, when no physician is available, 
it is important for the woman to know what is to 
be done. This chapter will tell how, in the ab- 
sence of medical advice, the various symptoms 
that may occur can be temporarily relieved. But 
whether or not she put those suggestions into 
practice, a woman should always place herself 
under the care of her physician. Though the ap- 
plication of the home remedy cause the symptoms 



TEMPORARY RELIEF OF SYMPTOMS 241 

temporarily to disappear, the diseased condition 
that produced them may still remain and even 
continue to grow progressively worse. When a 
woman puts herself under a doctor's care she 
must faithfully follow his directions. The phy- 
sician in attendance is familiar with the actual 
conditions present, and he knows best what 
should be done. Any suggestions as to treatment 
that might appear in a book such as this would 
be superfluous to a woman who is under compe- 
tent medical supervision. On the other hand, the 
sufferer who has foolishly put off seeking profes- 
sional advice might be led to still further postpone 
this necessary action, should she read of any 
methods of treatment. Many women die before 
their time because, instead of going at once to 
their family practitioner, they try a certain 
patent medicine or adopt some gratuitous sugges- 
tion of a well-meaning but ignorant neighbor, 
until finally the disease has acquired such a hold 
that a cure is no longer possible. 

Temporary Treatment of Pain. 

Pain is Nature's notification or warning that 
an abnormal condition is present. It is the con- 
dition causing the pain that is to be investigated 
and removed by treatment. For this the services 

16 



242 TEMPORARY RELIEF OF SYMPTOMS 

of a physician are required. Although the pain 
itself is seldom treated, yet there are times when 
it is so severe that something must be done to 
relieve it. As on such occasions a physician is 
not always within reach, it is important for a 
woman to be familiar with various expedients 
which may be tried before the doctor arrives. 
The procedures given in this chapter are of a 
temporary nature and only relieve the pain; they 
do not cure the condition producing it. 

The measures adopted for the relief of pain 
depend to some extent upon its location. 

Headache. 

Headache is frequently benefited by a cooling 
compress, consisting of a handkerchief or cloth 
tied across the forehead and kept cold by being 
repeatedly wrung out of cold or ice water. The 
compress is never allowed to become warm, being 
dipped in the cold water at frequent intervals. 

When this fails to relieve the headache, or 
tends to increase it, the stimulating cold compress 
may be tried. Several folds of muslin or linen — 
a handkerchief will answer — are wrung out of 
cold water and applied to the forehead. Over 
this a band of flannel is placed, extending for an 
inch above and below it, and reaching around the 



TEMPORARY RELIEF OF SYMPTOMS 243 

head, being tied, or fastened with pins. The in- 
side linen bandage will soon become warm, but 
it is not to be disturbed for at least an hour. It 
may then again be dipped in cold water and the 
bandage applied as before. 

Where both the cooling and the stimulating 
cold compress fail to give relief, a hot compress, 
or towel wrung out of hot water, may be tied 
around the head, or a menthol pencil may be 
rubbed over the temples and brows. A hot foot- 
bath, with or without mustard, or a hot or cold 
hip-bath or sitz-bath will often draw the blood 
from the head and thus relieve the headache. In 
every case a cathartic is indicated ; often it alone 
will work a cure. 

In every case, especially when the headaches 
always come while the eyes are being used for 
near work, such as reading, writing or sewing, 
the eyes should be examined by a competent 
oculist (not optician). 

Attention to hygienic rules, especially those in 
regard to work, rest, recreation and exercise, will 
aid largely in banishing headaches, which often 
are due to impoverished blood, overwork and lack 
of proper exercise, fresh air and sunlight. A gen- 
eral tired, languid, sleepy feeling, or a dull ache 
in the head, will frequently disappear after a 



244 TEMPORARY RELIEF OF SYMPTOMS 

brisk walk or a game of tennis or tether ball. A 
woman subject to headaches should always con- 
sult a physician. 

Backache. 

Pain in the back is not normal, although it is 
experienced by so many women. It may be due 
to displacement of the womb, to a tear, to a mov- 
able kidney, to rheumatism, or to other condi- 
tions. In every case an examination by a phy- 
sician is advisable. 

Backache is frequently caused by an improper 
mode of standing. Instead of the spine being 
held erect, the shoulders are pulled back and the 
abdomen thrown forward, which position im- 
poses a strain on the muscles of the back. An- 
other common cause of backache is the corset 
that is long behind and short and curved in at the 
waist in front. 

Pain in the back may be temporarily treated by 
local heat or cold, by massage or rubbing, or by 
counter-irritation with iodine or plasters. The 
latter sometimes give support to the back when 
the muscles or ligaments are strained. In such 
cases a tight bandage about the hips or a small 
hard pillow placed in the small of the back just 
above the hips will often afford relief. An ab- 



TEMPORARY RELIEF OF SYMPTOMS 245 

dominal bandage may prove of service when the 
pain is due to dropping of one or more of the 
abdominal organs and also in cases of strain. The 
substitution of a straight front corset for the im- 
proper kind frequently results in the disappear- 
ance of the backache. 

Abdominal Pains. 

Pain in the abdomen may be benefited by local 
heat, applied by means of a hot-water bag or 
cloths wrung out of hot water, to which some- 
times a teaspoonful of turpentine is added. A 
hot poultice of flaxseed or other material often 
soothes the pain. In cases where heat only in- 
creases the suffering, cold may be applied, 
usually in the form of an ice bag. When the 
abdomen is pendulous and lacks support, the pain 
may be due to a dropping of one or more of the 
organs. In such cases with the wearing of an 
abdominal elastic bandage the pain often disap- 
pears. This sagging of the abdomen may often 
be prevented if a woman holds herself properly. 
When attacked with severe abdominal pain a 
woman should at once go to bed and send for 
the doctor. 

If the pain seems to be in the lower portion of 
the abdomen, or in the pelvis, it may sometimes 



246 TEMPORARY RELIEF OF SYMPTOMS 

be relieved by heat applied to the parts internally 
by means of a vaginal douche, also known as an 
injection. A fountain syringe is filled with water 
as hot as can be borne, to which ordinary table 
salt has been added in the proportion of a tea- 
spoonful to a pint. The bag should be hung low, 
so as to let the water run out slowly. The heat 
supplied by the water is what does the good ; con- 
sequently the longer the injection lasts the better. 
A douche-pan or other receptacle is required to 
receive the water as it leaves the parts. 

A woman should regard as a danger signal of 
sufficient importance to warrant the immediate 
summoning of a physician, the occurrence of pain 
in the abdomen when severe and localized to one 
spot, or when associated with prostration, marked 
pallor, great abdominal tenderness, or chills and 
fever. 

A White Vaginal Discharge. 

Discharges from the vagina are of three kinds, 
white, yellow, and bloody. They may have little 
or grave significance. A physician should always 
be consulted to find out the cause and to prescribe 
the treatment. 

A white discharge, or leucorrhea, may be due 
to an acute or chronic inflammation of the neck 






TEMPORARY RELIEF OF SYMPTOMS 247 

of the womb, the glands being congested and se- 
creting a large amount of mucus, which finds its 
way externally. Leucorrhea, as a rule, is caused 
by some local or general condition. Its most 
common cause is a tear in the neck of the womb, 
which sets up an inflammation. It occurs also 
when the uterus is displaced or bent into an ab- 
normal position and also when after labor or 
miscarriage it fails to contract to its normal size. 
The use of frequent douches of cold water to pre- 
vent conception is said to produce it. An obsti- 
nate form is sometimes due to gonorrhea. In 
women with a tendency to consumption a white 
discharge is common, its severity depending en- 
tirely upon the general health. Leucorrhea may 
also be due to seat-worms, or to syphilis. 

The condition in many cases, especially where 
it occurs in young girls, is caused by a general 
state of ill health; in every instance the severity 
depends upon the general health. The leucorrhea 
may occur only at those times when the general 
health is impaired by overwork, anxiety, or by 
any other cause, and even when apparently cured, 
it is apt to reappear whenever the woman is sub- 
jected to such depressing influences. 

A physician must determine the cause. If the 
discharge be due to a displacement of the uterus 



248 TEMPORARY RELIEF OF SYMPTOMS 

or to a tear in the neck of that organ, it will not 
be cured until the tear is repaired or the womb 
put back in position. In some cases local treat- 
ment by the physician will be required. Hot 
douches usually aid in hastening the cure and, in 
the absence of a local cause, will be the only local 
treatment required. In most cases the physician 
will prescribe a tonic. The bowels must always 
be kept regular. When seat-worms are the cause, 
their removal effects a cure. 

In every case, whether the discharge is due to 
a general state of poor health or to a definite local 
cause, general hygienic measures are always 
necessary. 

A Yellow Discharge. 

The occurrence of a yellow discharge should 
receive immediate medical attention. It usually 
signifies gonorrhea, which in women is a very 
serious affection, being responsible for a large 
percentage of her pelvic troubles. 

A Bloody Discharge. 

At any other time than the menstrual period, 
a bloody flow is to be viewed with concern. A 
physician should always be consulted without 
delay. 



TEMPORARY RELIEF OF SYMPTOMS 249 

Increase in the amount of blood lost at the 
menstrual period and slight bleeding in the inter- 
val, occurring in women over thirty years of age, 
demand immediate and careful examination. 
They may indicate something very serious. Any 
bleeding from the vagina in a woman who has 
passed the menopause, or change of life, should 
arouse the gravest suspicion and be reported at 
once to the physician. Many dangerous and 
often fatal maladies begin in this way. 

Danger in Patent Medicines. 

Thousands of women to-day are ruining their 
health by taking patent medicines. These seem- 
ingly innocent remedies, often labelled "harm- 
less," frequently contain the most dangerous 
drugs. Few of the States have laws preventing 
the sale of such poisons, despite the fact that in 
many instances coroners' verdicts have ascribed 
the cause of death to their use. The makers of 
the patent medicines advertise in the daily news- 
papers, guaranteeing to cure every disease known 
to mankind. These advertisements are so cun- 
ningly and so attractively worded that a woman 
is deceived by their falsehoods and wastes her 
money on these harmful potions. After taking a 
bottle and finding her pain relieved by the opium 



250 TEMPORARY RELIEF OF SYMPTOMS 

it contains, and her strength seemingly restored 
by the alcohol which forms its chief ingredient, 
she imagines that she is on the road to recovery. 
Then bottle after bottle is consumed, while the 
disease grows progressively worse without at- 
tracting the woman's notice, so well are its symp- 
toms masked by the patent medicines. When at 
last the victim discovers her mistake, she too 
often is beyond all cure. 

The advertisements usually describe little aches 
and pains that are of no consequence, and state 
that they are symptoms of a serious disease which 
can best be cured by the use of the patent medi- 
cine recommended. Women in perfect health 
are thereby led to imagine that their organs are 
diseased, and thus acquire the drug-taking habit. 
There are hundreds of "sure cures for consump- 
tion" on the market, although the makers of these 
so-called "cures" well know that fresh air, good 
food, and proper hygienic living, alone will cure 
this disease. Most of these "consumption cures" 
contain chloroform and opium which may check 
or ease the cough, but which hasten the progress 
of the disease and shorten the life of the sufferer. 

Alcohol is the drug most commonly used in 
patent medicines. Most of the whiskey-cures 
contain it in very large quantities. The various 



TEMPORARY RELIEF OF SYMPTOMS 251 

"tonics," "sarsaparillas," "vegetable compounds," 
"celery compounds," "bitters," etc., contain as a 
rule more alcohol than is found in many intoxi- 
cating beverages. Beer, ale, stout and porter, for 
instance, average from three to eight per cent. 
of alcohol; a well-known patent medicine con- 
tains twenty-eight per cent. The alcohol in claret 
is nine per cent. ; in a much advertised sarsaparilla 
it is twenty-six per cent. 

The most dangerous of all the patent medicines, 
however, are the headache powders. The ma- 
jority of these contain a poison known as acetan- 
ilid, which has an injurious effect on the heart. 
Frequently after taking one of the powders a 
woman becomes faint and weak, her lips turn 
blue, her hands feel cold. In several instances 
death has shortly followed. In one case an 
eighteen-year-old girl went to a drug store for 
something to relieve her headache and was given 
a box of headache powders which are extensively 
advertised on sign boards and in street cars. As 
is usual with such patent medicines, there was 
nothing on the label to warn her of the dangerous 
nature of the drugs they contained. On the con- 
trary the claim was made that the medicine not 
only was harmless but strengthened the heart and 
produced better blood. The girl followed the 



252 TEMPORARY RELIEF OF SYMPTOMS 

printed directions and took two powders. In 
three hours she was dead. 

Often the heart of one who makes a practice 
of taking headache powders does not give way 
at once, but becomes w r eaker very gradually with- 
out causing noticeable symptoms, until during an 
attack of the grip or some other disease it is 
unable to stand the extra strain and then suddenly 
gives out. 

Cocaine is a drug which cannot be purchased 
from the apothecary under its own name, but 
which may easily be procured in a patent medi- 
cine. Most all the "catarrh powders" and "ca- 
tarrh cures" contain cocaine and consequently are 
harmful. The cocaine habit has often been 
formed by taking catarrh cures. 

In any illness the important fact for every 
woman to remember is that patent medicines as 
a rule are all dangerous. They may ease the pain, 
check the cough, or produce a temporary stimu- 
lation which gives a false impression of increased 
strength, but they never cure the disease. They 
merely mask or hide the symptoms for the time 
being. On the other hand they frequently do 
harm, causing the formation of drug habits, 
injuring the heart and sometimes even producing 
death. 




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